Crystal Angela White

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

105214 Issued in MD

Practice address

11006 Spring Forest Way
Fort Washington, MD 20744-4877

Phone

(301) 503-3978

NPI assigned

Aug 23, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Crystal Angela White Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534982400000",
    "number": "1174004535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11006 SPRING FOREST WAY",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207444877",
            "telephone_number": "301-503-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11006 SPRING FOREST WAY",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207444877",
            "telephone_number": "301-503-3978"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10903 Indian Head Hwy Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Washington",
            "state": "MD",
            "postal_code": "207444006",
            "country_code": "US",
            "telephone_number": "301-535-7367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "CRYSTAL",
        "middle_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MD",
            "license": "105214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "WHITE",
            "middle_name": "ANGELA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Fort Washington, MD
• Providers in Fort Washington, MD by specialty
• Prosthetic/Orthotic Supplier in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.