MEDICARE: MRS. CHRYSTAL MARIE PILGRIM PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	0110-007442	VA
2	363A00000X	Physician Assistant	C00006383	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110007442	OTHER	VA	LICENSE

General Provider Information

NPI Number	:	1902036775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRYSTAL MARIE PILGRIM PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	3060 WILLIAMS DR STE 3104
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4667
Country	:	US
Telephone Number	:	703-661-9484
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 WILLIAMS DR STE 3104
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4667
Country	:	US
Telephone Number	:	703-661-9484
Fax Number	:

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

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	03/05/2026

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