Provider Demographics
NPI:1144964180
Name:PEREIRA, KRISTAL NIKITA (MD)
Entity type:Individual
Prefix:MS
First Name:KRISTAL
Middle Name:NIKITA
Last Name:PEREIRA
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 1:3737 CHESTNUT STREET
Mailing Address - Street 2:APARTMENT 1404
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:856-493-0166
Mailing Address - Fax:
Practice Address - Street 1:1500 LANSDOWNE AVENUE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023
Practice Address - Country:US
Practice Address - Phone:610-237-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2023-03-27
Deactivation Date:2023-01-30
Deactivation Code:
Reactivation Date:2023-03-27
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program