Provider Demographics
NPI:1821290982
Name:VASILESCU, CRISTIAN MARIUS I (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:MARIUS
Last Name:VASILESCU
Suffix:I
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 1:9202 ELAM RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-4151
Mailing Address - Country:US
Mailing Address - Phone:214-266-1706
Mailing Address - Fax:
Practice Address - Street 1:1509 MAIN ST APT 502
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4808
Practice Address - Country:US
Practice Address - Phone:469-713-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99875207Q00000X, 208D00000X
TXP5245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285840YNJCOtherMEDICARE
TX285840YKP1OtherMEDICARE
TX285840YKP1OtherMEDICARE
TX285840YNJCMedicare PIN