Healthcare Provider Details

I. General information

NPI: 1225302854
Provider Name (Legal Business Name): ENTELA A KRISTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENTELA CANI

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHRISTIANA HOSPITAL, DEPARTMENT OF SURGERY 4755 OGLETOWN STANTON ROAD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

CCHS PHYSICIAN CONTRACTING, SUITE 2300 200 HYGEIA DRIVE
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-3475
  • Fax: 302-325-7056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055416
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000835
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: