Healthcare Provider Details

I. General information

NPI: 1306017231
Provider Name (Legal Business Name): ELLENTON PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 US HIGHWAY 301 N SUITE 102
ELLENTON FL
34222-3531
US

IV. Provider business mailing address

7915 US HIGHWAY 301 N STE 102
ELLENTON FL
34222-3532
US

V. Phone/Fax

Practice location:
  • Phone: 941-723-7877
  • Fax: 941-723-7844
Mailing address:
  • Phone: 941-723-7877
  • Fax: 941-723-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME100713
License Number StateFL

VIII. Authorized Official

Name: CRISTIAN CHIRITESCU
Title or Position: OWNER
Credential: MD
Phone: 941-723-7877