Provider Demographics
NPI:1942276548
Name:WILLIAMS, KRISTINA KALOR (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:KALOR
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:KALOR
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3900 QUEENSBURY RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3046
Mailing Address - Country:US
Mailing Address - Phone:301-699-6178
Mailing Address - Fax:301-699-8413
Practice Address - Street 1:3900 QUEENSBURY RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3046
Practice Address - Country:US
Practice Address - Phone:301-699-6178
Practice Address - Fax:301-699-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000011213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010097703Medicaid
4544790001OtherDMERC
DC027484400Medicaid
DC691201001Medicaid
4544790001OtherDMERC
DC015152W87Medicare ID - Type UnspecifiedTRAILBLAZER