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General NPI Number Information
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NPI Number | 1407930225
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Entity Type | Organization
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Legal Business Name | EASTERN PANHANDLE PSYCHIATRY, INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 51 STREET OF DREAMS
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City | MARTINSBURG
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State | WV
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Zip | 25403-1134
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Country | US
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Telephone | 304-264-1442
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Fax | 304-264-4317
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Provider Business Mailing Address
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Address Line | PO BOX 4056
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City | MARTINSBURG
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State | WV
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Zip | 25402-4056
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Country | US
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Telephone | 304-264-1442
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAHNOOR ALI KHAN
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Credential | MD
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Telephone | 703-400-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 20620
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License Number State | WV
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