Healthcare Provider Details

I. General information

NPI: 1730646290
Provider Name (Legal Business Name): HAGERSTOWN PSYCHIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 OAK HILL AVE STE 3
HAGERSTOWN MD
21742-2959
US

IV. Provider business mailing address

11123 COROBON LN
GREAT FALLS VA
22066-1403
US

V. Phone/Fax

Practice location:
  • Phone: 240-452-1623
  • Fax: 240-597-6620
Mailing address:
  • Phone: 304-279-9772
  • Fax: 703-763-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAHNOOR KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 703-400-3433