Provider Demographics
NPI:1609933803
Name:MEBANE MCGINTY, CRYSTAL (MD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MEBANE MCGINTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RUTH
Other - Last Name:MEBANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11106 LUTTRELL LN
Mailing Address - Street 2:SUITE 1500 NORTH
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3555
Mailing Address - Country:US
Mailing Address - Phone:240-498-4184
Mailing Address - Fax:301-649-3634
Practice Address - Street 1:11106 LUTTRELL LN
Practice Address - Street 2:SUITE 1500 NORTH
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3555
Practice Address - Country:US
Practice Address - Phone:240-498-4184
Practice Address - Fax:301-649-3634
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19387207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22056Medicare UPIN