Provider Demographics
NPI:1548407893
Name:GILGEOUS, CHRYSTINA MARIA (M AC)
Entity type:Individual
Prefix:MS
First Name:CHRYSTINA
Middle Name:MARIA
Last Name:GILGEOUS
Suffix:
Gender:F
Credentials:M AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CRADOCK ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4207
Mailing Address - Country:US
Mailing Address - Phone:301-775-6370
Mailing Address - Fax:
Practice Address - Street 1:2005 CRADOCK ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4207
Practice Address - Country:US
Practice Address - Phone:301-775-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist