Provider Demographics
NPI:1205897915
Name:WILLISON, CRYSTL D (MD)
Entity type:Individual
Prefix:
First Name:CRYSTL
Middle Name:D
Last Name:WILLISON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:220 CAMPUS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:9166 N CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:VA
Practice Address - Zip Code:22844-9422
Practice Address - Country:US
Practice Address - Phone:540-459-1340
Practice Address - Fax:540-459-1349
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-07-28
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Provider Licenses
StateLicense IDTaxonomies
VA0101230904207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF65540Medicare UPIN
VA140000193Medicare ID - Type Unspecified
VA6100023Medicaid
VA140000193Medicare ID - Type Unspecified