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General NPI Number Information
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NPI Number | 1750910857
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Entity Type | Organization
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Legal Business Name | INNOVATIVE TMS LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 9256 BENDIX RD STE 205
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City | COLUMBIA
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State | MD
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Zip | 21045-1848
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Country | US
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Telephone | 443-542-0773
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Fax | 443-542-0931
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Provider Business Mailing Address
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Address Line | 9256 BENDIX RD STE 205
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City | COLUMBIA
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State | MD
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Zip | 21045-1848
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Country | US
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Telephone | 319-331-3653
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Fax | 443-542-0931
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANANDRAJ MATTAI
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Credential | MD
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Telephone | 443-542-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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