Provider Demographics
NPI:1861454738
Name:CRITELLI, VIRGINIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LYNN
Last Name:CRITELLI
Suffix:
Gender:F
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:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-626-9626
Mailing Address - Fax:
Practice Address - Street 1:1717 NORTH E. STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-626-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME145120207RG0100X
GA44702207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108030600Medicaid
GA10BBCFVMedicare ID - Type Unspecified
CB5609OtherRRMEDICARE