Provider Demographics
NPI:1740228014
Name:KRISTAL, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KRISTAL
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 1:7806 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 RESEARCH BLVD
Practice Address - Street 2:350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3164
Practice Address - Country:US
Practice Address - Phone:301-838-9606
Practice Address - Fax:301-838-9029
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50864207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407235900Medicaid
601285800OtherFECA
MDG01485F30Medicare ID - Type UnspecifiedGROUP G01485
601285800OtherFECA
MD839M492FMedicare ID - Type UnspecifiedGROUP 839M