Provider Demographics
NPI:1225302854
Name:KRISTO, ENTELA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ENTELA
Middle Name:A
Last Name:KRISTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ENTELA
Other - Middle Name:
Other - Last Name:CANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CCHS PHYSICIAN CONTRACTING, SUITE 2300
Mailing Address - Street 2:200 HYGEIA DRIVE
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CHRISTIANA HOSPITAL, DEPARTMENT OF SURGERY
Practice Address - Street 2:4755 OGLETOWN STANTON ROAD
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-3475
Practice Address - Fax:302-325-7056
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055416363A00000X
363A00000X
DEC50000835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
334558XDKMedicare PIN