MEDICARE: DR. CRYSTAL LYNN MCKENRICK 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	207P00000X	Emergency Medicine Physician	MD421020	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356342729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL LYNN MCKENRICK MD

Provider Business Mailing Address
First Line	:	320 E NORTH AVE
Second Line	:	AGH EMERGENCY ASSOCS
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4756
Country	:	US
Telephone Number	:	412-359-4138
Fax Number	:	412-359-8874

Provider Business Practice Location Address
First Line	:	100 S JACKSON AVE
Second Line	:	AGH SUBURBAN CAMPUS AGH EMERG ASSOCS
City	:	PITTSBURGH
State	:	PA
Zip	:	15202-3428
Country	:	US
Telephone Number	:	412-734-6100
Fax Number	:	412-734-6932

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/23/2008

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