Provider Demographics
NPI:1225458748
Name:CRISTOL, JEREMY D (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:CRISTOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE, SUITE 2300
Mailing Address - Street 2:CCHS PHYSICIAN CONTRACTING
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 1:4735 OGLETOWN STANTON RD STE 1250
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2076
Practice Address - Country:US
Practice Address - Phone:302-623-0200
Practice Address - Fax:302-623-0267
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0012245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine