| Cognitive Medicine Practice Pllc | |
|
310 American Way Ste A Weirton WV 26062-4083 | |
| (304) 797-6410 | |
| (740) 797-6320 |
| Full Name | Cognitive Medicine Practice Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 310 American Way Ste A, Weirton, West Virginia |
| Authorized Official Name and Position | Richard O Ajayi (OWNER) |
| Authorized Official Contact | 3047976410 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Medicine Practice Pllc Po Box 6230 Wheeling WV 26003-0722 Ph: (304) 242-7106 | Cognitive Medicine Practice Pllc 310 American Way Ste A Weirton WV 26062-4083 Ph: (304) 797-6410 |
| NPI Number | 1760789093 |
|---|---|
| Provider Enumeration Date | 02/23/2011 |
| Last Update Date | 10/13/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 8527242759 |
|---|---|
| Medicare Enrollment ID | O20110412000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760789093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 20859 (West Virginia) | Primary |
| Provider Name | Navdeep S Purewal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881663094 PECOS PAC ID: 6305879792 Enrollment ID: I20050915000904 |
| Provider Name | Marcy L Crago |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902052079 PECOS PAC ID: 7113086794 Enrollment ID: I20081111000882 |
| Provider Name | Richard Olutoyin Ajayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902875743 PECOS PAC ID: 0042351124 Enrollment ID: I20100112000220 |
| Provider Name | Larry Gitelman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568438539 PECOS PAC ID: 2365548708 Enrollment ID: I20110701000296 |
| Provider Name | Giuliana F Mazza Congrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548507791 PECOS PAC ID: 7810128675 Enrollment ID: I20140320002063 |
| Provider Name | Luann Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407892136 PECOS PAC ID: 6709779085 Enrollment ID: I20160524000022 |
| Provider Name | Rhonda J. Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326325622 PECOS PAC ID: 5092961102 Enrollment ID: I20190111000323 |
| Provider Name | Erica Detrick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194005777 PECOS PAC ID: 3173849676 Enrollment ID: I20190723003123 |
| Provider Name | Julie Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336662154 PECOS PAC ID: 5890060222 Enrollment ID: I20190808001060 |
| Provider Name | Rachael M George Odutayo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396202479 PECOS PAC ID: 5799019436 Enrollment ID: I20190827002546 |
| Provider Name | Jessica Lynn Dickey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861090904 PECOS PAC ID: 1658781356 Enrollment ID: I20210308000699 |
| Provider Name | Saudat Iyabode Lawal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174224315 PECOS PAC ID: 5092161836 Enrollment ID: I20231030003413 |
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