Provider Demographics
NPI:1992758700
Name:CRISTESCU, MIRCEA GEORGE (MD)
Entity type:Individual
Prefix:
First Name:MIRCEA
Middle Name:GEORGE
Last Name:CRISTESCU
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 1:1839 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:727-822-8081
Practice Address - Street 1:1839 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:727-822-8081
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74342207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04489Medicare UPIN