Healthcare Provider Details

I. General information

NPI: 1386386803
Provider Name (Legal Business Name): CRISTAH PROST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 304-941-6059
  • Fax:
Mailing address:
  • Phone: 301-295-4771
  • Fax: 301-295-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101280166
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101280166
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: