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General NPI Number Information
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NPI Number | 1962752238
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Entity Type | Individual
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Provider Name | MARIA ABIGAIL CRYSTAL M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 8550 NE 138TH LANE THE OAKS AT 138TH, BLDG 800
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-391-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 13902 WELLINGTON LANE
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City | GRAND ISLAND
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State | FL
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Zip | 32735
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Country | US
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Telephone | 908-294-7665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME113825
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License Number State | FL
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