Healthcare Provider Details

I. General information

NPI: 1427157429
Provider Name (Legal Business Name): CRISTIAN V CHIRITESCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

7915 US 301 N SUITE 102
ELLENTON FL
34222-3531
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:
Title or Position:
Credential:
Phone: