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11110 Medical Campus Rd Ste 151 Hagerstown MD 21742-6755 | |
| (301) 797-7600 | |
| (301) 517-7636 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 11110 Medical Campus Rd Ste 151, Hagerstown, Maryland |
| Authorized Official Name and Position | Sarim Rahman Mir (PRESIDENT, SENIOR NEUROLOGIST) |
| Authorized Official Contact | 3017977600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11110 Medical Campus Rd Ste 151 Hagerstown MD 21742-6755 Ph: (301) 797-7600 | 11110 Medical Campus Rd Ste 151 Hagerstown MD 21742-6755 Ph: (301) 797-7600 |
| NPI Number | 1518905439 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 7618956814 |
|---|---|
| Medicare Enrollment ID | O20040720000070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518905439 | NPI | - | NPPES |
| DC5469 | Other | MD | MEDICARE RR PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Sarim R Mir |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497793087 PECOS PAC ID: 8426037623 Enrollment ID: I20040720000104 |
| Provider Name | Mehrullah Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1578564761 PECOS PAC ID: 4385771112 Enrollment ID: I20100427000286 |
| Provider Name | Danielle Ayers Henchey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841625654 PECOS PAC ID: 9638457856 Enrollment ID: I20200316000268 |
| Provider Name | Olivia Perrelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285111880 PECOS PAC ID: 2860820966 Enrollment ID: I20200512000010 |
| Provider Name | Shannon Nicole Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962001818 PECOS PAC ID: 5294141685 Enrollment ID: I20210310000120 |
| Provider Name | Chandler B Trecost |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821701129 PECOS PAC ID: 6709244312 Enrollment ID: I20230614000347 |
| Provider Name | Haleigh Doane |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255979423 PECOS PAC ID: 4486187523 Enrollment ID: I20241029001565 |
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