Melanie Nicole Cristobal, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS043634 Issued in PA

Practice address

401-55 W Allegheny Avenue
Philadelphia, PA 19133

Phone

(215) 291-2500

Fax

(215) 291-2587

NPI assigned

Jun 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: melanie.cristobal.p1@direct.dvch.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Delaware Valley Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1386864502
  Medicare reassignment NPD
• Delaware Valley Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1235956921
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1699343244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412-22 FAIRMOUNT AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-684-5344",
            "fax_number": "215-232-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401-55 W ALLEGHENY AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19133",
            "telephone_number": "215-291-2500",
            "fax_number": "215-291-2587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISTOBAL",
        "first_name": "MELANIE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS043634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Gabriela Cristancho, M.D., PH.D.
• Daniel Antonio Cristancho, M.D.
• Roxanne Sebeny Cristancho, CRNP
• Caitlin Anne Cristante, MD
• Veronica Cristiano
• Elizabeth Adele Cristofalo, M.D.
• Jorie Marissa Cristy, PHARMD
• Critical Care Medicine Services LLC
• Paul Crits-Christoph, PHD
• Margaret Lord Crivello, MD

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.