MEDICARE: KRYSTAL MEDICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1578248787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRYSTAL MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	3602 BALIN CT
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-1301
Country	:	US
Telephone Number	:	703-209-0363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 BALIN CT
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-1301
Country	:	US
Telephone Number	:	703-209-0363
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. NWAEHIHIE HARRISON ONYEAGHALA
Credential	:	MD
Telephone Number	:	703-209-0363

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/16/2023

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