Provider Demographics
NPI:1700014198
Name:DICKSON, CRYSTAL MEERA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MEERA
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:MEERA
Other - Last Name:SHRESTHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:810 WH SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3763
Mailing Address - Country:US
Mailing Address - Phone:252-757-2663
Mailing Address - Fax:434-654-5574
Practice Address - Street 1:810 WH SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3763
Practice Address - Country:US
Practice Address - Phone:252-757-2663
Practice Address - Fax:434-654-5574
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262902207X00000X, 207XX0004X
PAMT195182207X00000X
NC2022-01895207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery