| Hagerstown Psychiatry Inc | |
|
12821 Oak Hill Ave Ste 3 Hagerstown MD 21742-2959 | |
| (240) 452-1623 | |
| (240) 597-6620 |
| Full Name | Hagerstown Psychiatry Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12821 Oak Hill Ave Ste 3, Hagerstown, Maryland |
| Authorized Official Name and Position | Shahnoor 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 |
|---|---|
| Hagerstown Psychiatry Inc 11123 Corobon Ln Great Falls VA 22066-1403 Ph: (304) 279-9772 | Hagerstown Psychiatry Inc 12821 Oak Hill Ave Ste 3 Hagerstown MD 21742-2959 Ph: (240) 452-1623 |
| NPI Number | 1730646290 |
|---|---|
| Provider Enumeration Date | 02/20/2019 |
| Last Update Date | 03/03/2020 |
| Certification Date | 03/03/2020 |
| Medicare PECOS PAC ID | 6406284272 |
|---|---|
| Medicare Enrollment ID | O20200311000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730646290 | NPI | - | NPPES |
| D0064888 | Other | MD | STATE MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Shahnoor Ali Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346342458 PECOS PAC ID: 6103719323 Enrollment ID: I20200311000051 |
| Provider Name | Carole Tchatchoua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447718549 PECOS PAC ID: 2466861356 Enrollment ID: I20210518001665 |
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