Healthcare Provider Details

I. General information

NPI: 1790764165
Provider Name (Legal Business Name): MICSUNICA-ELVIRA CHIRITESCU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 PEMBERTON HILL RD SUITE 201
APEX NC
27502-4269
US

IV. Provider business mailing address

1091 PEMBERTON HILL RD SUITE 201
APEX NC
27502-4269
US

V. Phone/Fax

Practice location:
  • Phone: 919-367-2499
  • Fax: 919-367-3608
Mailing address:
  • Phone: 919-367-2499
  • Fax: 919-367-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier49668
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerWELLPATH
# 2
Identifier89129ER
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
IdentifierP00211751
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier129ER
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS / BLUE SHIELD
# 5
Identifier0007456221
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerAETNA
# 6
Identifier0300074
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerUNITED HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: