Organization
KRYSTAL MEDICAL ASSOCIATES LLC
Active
Other names
Krystal Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NWAEHIHIE H ONYEAGHALA M.D. (PRESIDENT)
(301) 486-0100
Entity
Organization
Contact information
Practice address
12150 ANNAPOLIS RD, SUITE 100, GLENN DALE, MD 20769-9183
(301) 464-7601
(866) 885-9817
Mailing address
12150 ANNAPOLIS RD, SUITE 100, GLENN DALE, MD 20769-9183
(301) 464-7601
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
Enumeration date
11/30/2007
Last updated
08/18/2014
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