Basic Information
| Provider Information | |||||||||
| NPI: | 1043300544 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | IONITA | ||||||||
| FirstName: | CRISTIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | CUMG | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 282 WASHINGTON ST | ||||||||
| Address2: | CONNECTICUT CHILDREN'S SPECIALTY GROUP | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | E-4328 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0400X | E-4328 | AR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0402X | E-4328 | AR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 2084N0402X | MD60465754 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 208000000X | MD60465754 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0008X | MD60465754 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine | 2084N0400X | MD60465754 | WA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0402X | 048575 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 158325001 | 05 | AR | MEDICAID |