Healthcare Provider Details

I. General information

NPI: 1245287176
Provider Name (Legal Business Name): GEOFFREY WOLFE KRYSTAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD MCGUIRE VETERANS AFFAIRS MEDICAL CENTER 111K
RICHMOND VA
23249
US

IV. Provider business mailing address

9533 PINE SHADOW DR
RICHMOND VA
23238-4457
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5446
  • Fax: 804-675-5447
Mailing address:
  • Phone: 804-346-8250
  • Fax: 804-675-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101043049
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: