Healthcare Provider Details

I. General information

NPI: 1518820331
Provider Name (Legal Business Name): CRYSTAL LYNN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

7916 WYNNWOOD DR
CLINTON MD
20735-2049
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-8450
  • Fax: 202-388-4339
Mailing address:
  • Phone: 301-732-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: