Provider Demographics
NPI:1407010143
Name:CRISTANCHO PIMIENTO, MARIO A (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:CRISTANCHO PIMIENTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3309
Mailing Address - Country:US
Mailing Address - Phone:215-746-6700
Mailing Address - Fax:215-746-5155
Practice Address - Street 1:3535 MARKET STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3309
Practice Address - Country:US
Practice Address - Phone:215-746-6700
Practice Address - Fax:215-746-5155
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1938552084P0800X, 390200000X
PAMD4436662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program