Healthcare Provider Details

I. General information

NPI: 1982114047
Provider Name (Legal Business Name): KRYSTAL ALCOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 HANOVER DR STE 104
GREENBELT MD
20770-2250
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 900
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-486-4690
  • Fax:
Mailing address:
  • Phone: 301-982-2000
  • Fax: 301-982-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9110801
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC07542
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: