Provider Demographics
NPI:1558408542
Name:WATKINS, CRYSTAL CHANEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:CHANEL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:WATKINS
Other - Last Name:JOHANSSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 64260
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:THE JOHNS HOPKINS HOSPITAL
Practice Address - Street 2:600 NORTH WOLFE STREET, MEYER 131
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-6114
Practice Address - Fax:410-614-5914
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT48362084P0800X
MDD721882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403095800Medicaid
MD216641YX3Medicare PIN