1457989261 NPI number — DR. CHRYSTAL LYNETTE PRISTELL DO

Table of content: ANAHI PARSONS (NPI 1235253311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457989261 NPI number — DR. CHRYSTAL LYNETTE PRISTELL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRISTELL
Provider First Name:
CHRYSTAL
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457989261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 FRANKLIN SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-777-2000
Provider Business Mailing Address Fax Number:
443-777-8489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4414 BENNING RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20019-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
22-469-4699
Provider Business Practice Location Address Fax Number:
443-777-8489
Provider Enumeration Date:
03/28/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  DO210001797 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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