Provider Demographics
NPI:1477112811
Name:KALOGRIS, CRYSTAL (DO)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:KALOGRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:419-520-2495
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:130 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1117
Practice Address - Country:US
Practice Address - Phone:740-692-4450
Practice Address - Fax:740-692-4451
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11020373A207Q00000X
OH34.015799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492146Medicaid