Provider Demographics
NPI:1578773511
Name:AITELLI, CRISTI LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CRISTI
Middle Name:LYNN
Last Name:AITELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:6500 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4136
Practice Address - Country:US
Practice Address - Phone:817-346-6748
Practice Address - Fax:817-263-2615
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10016834390200000X
TXN1521207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204073501Medicaid
TX204073502Medicaid
TXP00831393OtherRAILROAD MEDICARE
TX204073502Medicaid
TXP00831393OtherRAILROAD MEDICARE