Provider Demographics
NPI:1104002864
Name:TYSON, CRYSTAL CENELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:CENELL
Last Name:TYSON
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 1:3475 ERWIN ROAD
Mailing Address - Street 2:SUITE 100, BOX 3487
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-660-6626
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY MEDCIAL CTR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-660-6626
Practice Address - Fax:919-660-6849
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-12
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086590207R00000X
NC2011-01798207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine