Provider Demographics
NPI:1578248787
Name:KRYSTAL MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:KRYSTAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NWAEHIHIE
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:ONYEAGHALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-209-0363
Mailing Address - Street 1:3602 BALIN CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1301
Mailing Address - Country:US
Mailing Address - Phone:703-209-0363
Mailing Address - Fax:
Practice Address - Street 1:3602 BALIN CT
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1301
Practice Address - Country:US
Practice Address - Phone:703-209-0363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRYSTAL MEDICAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care