Healthcare Provider Details

I. General information

NPI: 1760770853
Provider Name (Legal Business Name): HIGHLAND MEDICAL PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13440 CLARKSVILLE PIKE
HIGHLAND MD
20777
US

IV. Provider business mailing address

13440 CLARKSVILLE PIKE
HIGHLAND MD
20777
US

V. Phone/Fax

Practice location:
  • Phone: 301-854-0021
  • Fax: 301-854-0255
Mailing address:
  • Phone: 301-854-0021
  • Fax: 301-854-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0031560
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0031560
License Number StateMD

VIII. Authorized Official

Name: DR. RIFFAT S. ASHAI
Title or Position: PRESIDENT
Credential: MD
Phone: 301-854-0021