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General NPI Number Information
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NPI Number | 1255099545
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Entity Type | Organization
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Legal Business Name | MAGELLAN PROVIDER SERVICES, P.A.
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 6303 COWBOYS WAY STE 350
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City | FRISCO
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State | TX
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Zip | 75034-0335
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Country | US
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Telephone | 866-605-0634
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Fax |
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Provider Business Mailing Address
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Address Line | 8621 ROBERT FULTON DR
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City | COLUMBIA
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State | MD
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Zip | 21046-2620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAO HARIS NASEEM
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Credential | MD
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Telephone | 940-565-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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