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Individual
MR. LOUIS T DECRISTOFARO
Active
Individual
MR. LOUIS T DECRISTOFARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0009
TN
363A00000X
Physician Assistant
Primary
103541
NC
363A00000X
Physician Assistant
2669
GA
363A00000X
Physician Assistant
A398
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009
TN PA LICENSE PHYS ASSIST
TN
01
—
0018629
AAPA MEMBER ID
NC
01
—
1012656
NCCPA MEMBER ID
NC
01
—
103541
NC PA LICENSE PHYS ASSIST
NC
01
—
111717
NC PA CERTIFICATION NO
NC
01
—
2669
GA PA LICENSE PHYS ASSIST
GA
01
—
A398
SC PA LICENSE PHYS ASSIST
SC
Enumeration date
09/18/2005
Last updated
12/23/2009
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