Provider Demographics
NPI:1265724181
Name:CRISANTI, MARIA CECILIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:CRISANTI
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 1:2314 SASSAFRAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2722
Mailing Address - Country:US
Mailing Address - Phone:814-454-4484
Mailing Address - Fax:814-452-1809
Practice Address - Street 1:2314 SASSAFRAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2722
Practice Address - Country:US
Practice Address - Phone:814-454-4484
Practice Address - Fax:814-452-1809
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD453069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine