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General NPI Number Information
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NPI Number | 1306017231
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Entity Type | Organization
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Legal Business Name | ELLENTON PEDIATRICS PA
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 7915 US HIGHWAY 301 N SUITE 102
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City | ELLENTON
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State | FL
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Zip | 34222-3531
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Country | US
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Telephone | 941-723-7877
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Fax | 941-723-7844
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Provider Business Mailing Address
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Address Line | 7915 US HIGHWAY 301 N STE 102
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City | ELLENTON
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State | FL
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Zip | 34222-3532
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Country | US
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Telephone | 941-723-7877
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Fax | 941-723-7844
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Authorized Official
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Title or Position | OWNER
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Name | CRISTIAN CHIRITESCU
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Credential | MD
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Telephone | 941-723-7877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME100713
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License Number State | FL
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