Provider Demographics
NPI:1548853856
Name:MARTIN, CRYSTAL G
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5925
Mailing Address - Country:US
Mailing Address - Phone:304-280-6066
Mailing Address - Fax:
Practice Address - Street 1:121 S PARK ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5925
Practice Address - Country:US
Practice Address - Phone:304-280-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker