Healthcare Provider Details

I. General information

NPI: 1205897915
Provider Name (Legal Business Name): CRYSTL D WILLISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9166 N CONGRESS ST
NEW MARKET VA
22844-9422
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 210
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-1340
  • Fax: 540-459-1349
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101230904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: