MEDICARE: CRISTINA MARIA MISA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	167743	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477717692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MARIA MISA M.D.

Provider Business Mailing Address
First Line	:	10744 MAIN STREET
Second Line	:	PO BOX 388
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111-0000
Country	:	US
Telephone Number	:	716-337-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	10744 MAIN STREET
Second Line	:
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111-0000
Country	:	US
Telephone Number	:	716-337-3010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	03/08/2011

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