Provider Demographics
NPI:1114962537
Name:CAMPASSI, CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:CAMPASSI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CRESTVIEW RD # 8
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4245
Mailing Address - Country:US
Mailing Address - Phone:104-736-3905
Mailing Address - Fax:
Practice Address - Street 1:8 CRESTVIEW RD # 8
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4245
Practice Address - Country:US
Practice Address - Phone:410-736-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00608352085R0202X
MA10207282085R0202X
NY3322642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403033800Medicaid
MDH380S921Medicare PIN
MD527LJ684Medicare PIN
P00172192Medicare PIN
H96171Medicare UPIN