Healthcare Provider Details

I. General information

NPI: 1598409286
Provider Name (Legal Business Name): MOLLY JO DECRISTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6013 FARRINGTON RD STE 301
CHAPEL HILL NC
27517-8173
US

IV. Provider business mailing address

PEDIATRIC EDUCATION OFFICE CAMPUS BOX 7593
CHAPEL HILL NC
27599-7593
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-6669
  • Fax: 984-974-9609
Mailing address:
  • Phone: 919-966-3172
  • Fax: 919-966-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2025-00731
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025-00731
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: