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Organization
KRYSTAL MEDICAL ASSOCIATES LLC
Active
Organization
KRYSTAL MEDICAL ASSOCIATES LLC
Active
Other names
Krystal Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
NWAEHIHIE HARRISON ONYEAGHALA (OWNER)
(301) 464-7601
Entity
Organization
Contact information
Practice address
12150 ANNAPOLIS RD STE 100, GLENN DALE, MD 20769-9183
(301) 464-7601
(866) 885-9817
Mailing address
PO BOX 7321, LARGO, MD 20792-7321
(301) 464-7601
(866) 885-9817
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
D0053461
MD
261QP2300X
Primary Care Clinic/Center
Primary
D0053461
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010012902
—
VA
05
—
034934800
—
DC
05
—
402647100
—
MD
05
—
552123800
—
MD
Enumeration date
11/30/2007
Last updated
09/04/2026
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