Healthcare Provider Details

I. General information

NPI: 1932592441
Provider Name (Legal Business Name): NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2015
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FLEET ST STE 136 C/O NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.
OXON HILL MD
20745-1548
US

IV. Provider business mailing address

5627 ALLENTOWN RD UNIT 100
CAMP SPRINGS MD
20746-4520
US

V. Phone/Fax

Practice location:
  • Phone: 301-899-8910
  • Fax: 301-899-8915
Mailing address:
  • Phone: 301-241-0255
  • Fax: 240-455-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD0072664
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD0072664
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SHANIQUE CARTWRIGHT
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-633-3175