| Eastern Panhandle Psychiatry, Inc | |
|
51 Street Of Dreams Martinsburg WV 25403-1134 | |
| (304) 264-1442 | |
| (304) 264-4317 |
| Full Name | Eastern Panhandle Psychiatry, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 51 Street Of Dreams, Martinsburg, West Virginia |
| Authorized Official Name and Position | Shahnoor Ali Khan (PRESIDENT) |
| Authorized Official Contact | 7034003433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Panhandle Psychiatry, Inc Po Box 4056 Martinsburg WV 25402-4056 Ph: (304) 264-1442 | Eastern Panhandle Psychiatry, Inc 51 Street Of Dreams Martinsburg WV 25403-1134 Ph: (304) 264-1442 |
| NPI Number | 1407930225 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 03/07/2023 |
| Certification Date | 02/28/2020 |
| Medicare PECOS PAC ID | 9931154176 |
|---|---|
| Medicare Enrollment ID | O20050321000594 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407930225 | NPI | - | NPPES |
| 1346342458 | Other | WV | INDIVIDUAL NPI |
| 2000700000 | Medicaid | WV | |
| 20620 | Other | WV | WV LICENSE |
| D0064888 | Other | MD | MD LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 20620 (West Virginia) | Primary |
| Provider Name | Shahnoor Ali Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346342458 PECOS PAC ID: 6103719323 Enrollment ID: I20040203000457 |
| Provider Name | Joseph A Jurand |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841280765 PECOS PAC ID: 6305846031 Enrollment ID: I20070103000345 |
| Provider Name | Mary Wharton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356775837 PECOS PAC ID: 3779835061 Enrollment ID: I20181015003383 |
| Provider Name | Camilla Rebuck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508106550 PECOS PAC ID: 2860744034 Enrollment ID: I20181016003870 |
| Provider Name | Barbara Kadesky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891246724 PECOS PAC ID: 9638422751 Enrollment ID: I20181018002918 |
| Provider Name | Susan Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114580347 PECOS PAC ID: 9234559170 Enrollment ID: I20201015000857 |
| Provider Name | Carole Tchatchoua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447718549 PECOS PAC ID: 2466861356 Enrollment ID: I20210623000155 |
| Provider Name | Deana L Sassaman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134847619 PECOS PAC ID: 1557738606 Enrollment ID: I20221103000407 |
| Provider Name | Alta Carmelle Chery-leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265790075 PECOS PAC ID: 0244603751 Enrollment ID: I20231103001946 |
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