MEDICARE: CRYSTL D WILLISON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	0101230904	VA

General Provider Information

NPI Number	:	1205897915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTL D WILLISON MD

Provider Business Mailing Address
First Line	:	220 CAMPUS BLVD STE 210
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2889
Country	:	US
Telephone Number	:	540-536-5100
Fax Number	:	540-536-0235

Provider Business Practice Location Address
First Line	:	9166 N CONGRESS ST
Second Line	:
City	:	NEW MARKET
State	:	VA
Zip	:	22844-9422
Country	:	US
Telephone Number	:	540-459-1340
Fax Number	:	540-459-1349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/28/2023

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