| Cornerstone Montgomery, Inc. | |
|
6040 Southport Dr Bethesda MD 20814-1848 | |
| (301) 493-4200 | |
| (301) 493-6209 |
| Full Name | Cornerstone Montgomery, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6040 Southport Dr, Bethesda, Maryland |
| Authorized Official Name and Position | Michael Ostrowski (BILLING SUPERVISOR) |
| Authorized Official Contact | 3014934200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Montgomery, Inc. 6040 Southport Dr Bethesda MD 20814-1848 Ph: (301) 493-4200 | Cornerstone Montgomery, Inc. 6040 Southport Dr Bethesda MD 20814-1848 Ph: (301) 493-4200 |
| NPI Number | 1194725739 |
|---|---|
| Provider Enumeration Date | 07/26/2005 |
| Last Update Date | 02/18/2020 |
| Certification Date | 02/18/2020 |
| Medicare PECOS PAC ID | 3971591751 |
|---|---|
| Medicare Enrollment ID | O20040501000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194725739 | NPI | - | NPPES |
| WST000010 | Other | VA | VALUEOPTIONS |
| 837AST | Other | MD | BLUE CROSS BLUE SHIELD |
| 2525020-00 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ijaz Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073653473 PECOS PAC ID: 6709851389 Enrollment ID: I20040827000347 |
| Provider Name | Ruth Murray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679785281 PECOS PAC ID: 2860452075 Enrollment ID: I20041012001598 |
| Provider Name | Ricardo Adrian Rius |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295751907 PECOS PAC ID: 1052203981 Enrollment ID: I20041204000168 |
| Provider Name | Simona Pick Both |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043246614 PECOS PAC ID: 7214982941 Enrollment ID: I20050316000121 |
| Provider Name | Sarah N Hammack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164579306 PECOS PAC ID: 5294757415 Enrollment ID: I20051230000403 |
| Provider Name | Derwin Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952403115 PECOS PAC ID: 6507868619 Enrollment ID: I20070202000112 |
| Provider Name | Lawrence Dubester |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548221716 PECOS PAC ID: 0345285771 Enrollment ID: I20080410000141 |
| Provider Name | Kelly Gill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942456587 PECOS PAC ID: 9739249459 Enrollment ID: I20081125000273 |
| Provider Name | Andrea Lozouski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568681757 PECOS PAC ID: 7113053877 Enrollment ID: I20100405000177 |
| Provider Name | Sharon B Fischman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568645059 PECOS PAC ID: 0749319580 Enrollment ID: I20100603000542 |
| Provider Name | Julia Frank |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306811047 PECOS PAC ID: 2466645932 Enrollment ID: I20101018000672 |
| Provider Name | Aldrin O Ceballos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811275423 PECOS PAC ID: 6901078880 Enrollment ID: I20111019000457 |
| Provider Name | Frances Claytor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487682043 PECOS PAC ID: 6406022904 Enrollment ID: I20120112000406 |
| Provider Name | Marium Parveen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740320134 PECOS PAC ID: 4789841412 Enrollment ID: I20120207000590 |
| Provider Name | Leah Kuperman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558680769 PECOS PAC ID: 2668630229 Enrollment ID: I20120228000698 |
| Provider Name | David Peet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710228325 PECOS PAC ID: 6002051166 Enrollment ID: I20130321000203 |
| Provider Name | Georgia Munson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013101773 PECOS PAC ID: 0446498380 Enrollment ID: I20130604000613 |
| Provider Name | Muhammad Naeem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609158062 PECOS PAC ID: 0446426308 Enrollment ID: I20140325000069 |
| Provider Name | Sergey Istomin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023384963 PECOS PAC ID: 1658503347 Enrollment ID: I20140411000342 |
| Provider Name | Charles J Schneiderhan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043642507 PECOS PAC ID: 2264656628 Enrollment ID: I20140605001001 |
| Provider Name | Devika Krishnan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972584332 PECOS PAC ID: 6406037126 Enrollment ID: I20140821001631 |
| Provider Name | Maria Castineira Garcia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730382599 PECOS PAC ID: 9133341928 Enrollment ID: I20141111001688 |
| Provider Name | Raymond A Ofe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003168964 PECOS PAC ID: 6204149693 Enrollment ID: I20150714001538 |
| Provider Name | Shana R Mizzer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437320413 PECOS PAC ID: 1052612140 Enrollment ID: I20151215000366 |
| Provider Name | Ana C San Martin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093032179 PECOS PAC ID: 5698076479 Enrollment ID: I20151221001670 |
| Provider Name | Patrice Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023265238 PECOS PAC ID: 9830112648 Enrollment ID: I20160315001375 |
| Provider Name | Jae Hoon Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760726525 PECOS PAC ID: 6901042993 Enrollment ID: I20160504001462 |
| Provider Name | Antonia Chantal Tsutsumi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861766610 PECOS PAC ID: 8022302678 Enrollment ID: I20160804002431 |
| Provider Name | Xiujun Zhao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326205261 PECOS PAC ID: 6800931171 Enrollment ID: I20160913000144 |
| Provider Name | Agerie A Ejigu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871044784 PECOS PAC ID: 7416237011 Enrollment ID: I20161216000075 |
| Provider Name | Rakesh K Bansil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811982499 PECOS PAC ID: 6800867839 Enrollment ID: I20171205000269 |
| Provider Name | Renata B Nkeze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689925497 PECOS PAC ID: 9032473277 Enrollment ID: I20180516000333 |
| Provider Name | Millicent Boa Amponsem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659858769 PECOS PAC ID: 1658615570 Enrollment ID: I20181204002414 |
| Provider Name | Caitlin Marie Elsenbeck |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497173926 PECOS PAC ID: 0941545099 Enrollment ID: I20181219000087 |
| Provider Name | David Lee Dunnigan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124003066 PECOS PAC ID: 8820399942 Enrollment ID: I20190507000840 |
| Provider Name | Gaelle Nyasa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144781196 PECOS PAC ID: 7113251596 Enrollment ID: I20190712000881 |
| Provider Name | Peter White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063614865 PECOS PAC ID: 7911046800 Enrollment ID: I20191024001512 |
| Provider Name | William Haynes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831610161 PECOS PAC ID: 5092086611 Enrollment ID: I20191112002971 |
| Provider Name | Wubeshet Tesema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134760036 PECOS PAC ID: 6709212889 Enrollment ID: I20200210000432 |
| Provider Name | Sarah Wempe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447621925 PECOS PAC ID: 4183980147 Enrollment ID: I20200317000671 |
| Provider Name | Nadine Kakanou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063044279 PECOS PAC ID: 9739599374 Enrollment ID: I20201110000914 |
| Provider Name | Valerie Elizabeth Hinrichs |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457703357 PECOS PAC ID: 8628485257 Enrollment ID: I20210329000503 |
| Provider Name | Matthew L Leshchiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801478433 PECOS PAC ID: 6901208677 Enrollment ID: I20210719000404 |
| Provider Name | John Danna |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699102053 PECOS PAC ID: 2264813807 Enrollment ID: I20220714000144 |
| Provider Name | Henriette Ghapsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588249890 PECOS PAC ID: 4486027752 Enrollment ID: I20230307002434 |
| Provider Name | Chynwe Ahumaraeze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942572540 PECOS PAC ID: 3678732740 Enrollment ID: I20230419002870 |
| Provider Name | Nadimire Jules-dole |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750657987 PECOS PAC ID: 9638420029 Enrollment ID: I20230525000795 |
| Provider Name | Victoria Akpan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750052817 PECOS PAC ID: 4082929500 Enrollment ID: I20231124000350 |
| Provider Name | Julianne Tortolano Retzer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922582824 PECOS PAC ID: 7810331238 Enrollment ID: I20240213004604 |
| Provider Name | Munsu Kwon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750446779 PECOS PAC ID: 4082059092 Enrollment ID: I20240229002848 |
| Provider Name | Adom Fermanian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437725694 PECOS PAC ID: 0840684841 Enrollment ID: I20240321003245 |
| Provider Name | Joy H Chang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154620540 PECOS PAC ID: 7911210851 Enrollment ID: I20240403001869 |
| Provider Name | Naomi Catherine Kabasela |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104905454 PECOS PAC ID: 8224478268 Enrollment ID: I20240424003399 |
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