Provider Demographics
NPI:1306017231
Name:ELLENTON PEDIATRICS PA
Entity Type:Organization
Organization Name:ELLENTON PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRITESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-723-7877
Mailing Address - Street 1:7915 US HIGHWAY 301 N STE 102
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-3532
Mailing Address - Country:US
Mailing Address - Phone:941-723-7877
Mailing Address - Fax:941-723-7844
Practice Address - Street 1:7915 US HIGHWAY 301 N
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3531
Practice Address - Country:US
Practice Address - Phone:941-723-7877
Practice Address - Fax:941-723-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH52177Medicare UPIN