| North Village | |
|
18714 N Village Shopping Center Hagerstown MD 21742-2454 | |
| (301) 733-0330 | |
| (301) 733-4038 |
| Full Name | North Village |
|---|---|
| Speciality | Clinic/Center |
| Location | 18714 N Village, Hagerstown, Maryland |
| Authorized Official Name and Position | Jamie Lea Barkdoll (CRED COORDINATOR) |
| Authorized Official Contact | 3017330331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Village 13121 Brook Lane Hagerstown MD 21742-1514 Ph: (301) 733-0331 | North Village 18714 N Village Shopping Center Hagerstown MD 21742-2454 Ph: (301) 733-0330 |
| NPI Number | 1417928151 |
|---|---|
| Provider Enumeration Date | 01/31/2006 |
| Last Update Date | 10/01/2018 |
| Medicare PECOS PAC ID | 9436140068 |
|---|---|
| Medicare Enrollment ID | O20040521000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417928151 | NPI | - | NPPES |
| 698800800 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 12391 (Maryland) | Primary |
| Provider Name | Susan Corley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932170594 PECOS PAC ID: 4688629108 Enrollment ID: I20050317000670 |
| Provider Name | Vicki S Churchey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023105483 PECOS PAC ID: 9234167487 Enrollment ID: I20050729000537 |
| Provider Name | John H Carrill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821063124 PECOS PAC ID: 3577621945 Enrollment ID: I20081029000463 |
| Provider Name | Corvin V Robinson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548244841 PECOS PAC ID: 0244216927 Enrollment ID: I20090217000206 |
| Provider Name | Maximilian Badoy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902954902 PECOS PAC ID: 5991795791 Enrollment ID: I20090331000416 |
| Provider Name | Michelle K Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417928086 PECOS PAC ID: 7012064306 Enrollment ID: I20090402000011 |
| Provider Name | Donna J Fogle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982828448 PECOS PAC ID: 0941340194 Enrollment ID: I20091218000180 |
| Provider Name | Tiesha Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104082346 PECOS PAC ID: 4385770478 Enrollment ID: I20100329000031 |
| Provider Name | Christine N Kitchen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295935617 PECOS PAC ID: 0648463901 Enrollment ID: I20101019000645 |
| Provider Name | Jamal K Fawaz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003881335 PECOS PAC ID: 4981899614 Enrollment ID: I20101108001219 |
| Provider Name | Olga Demina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467633768 PECOS PAC ID: 9537236500 Enrollment ID: I20110926000114 |
| Provider Name | Andrew Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972584233 PECOS PAC ID: 1052483112 Enrollment ID: I20111108000478 |
| Provider Name | Janell K Budgett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346526050 PECOS PAC ID: 8426223272 Enrollment ID: I20111207000161 |
| Provider Name | Gratia Johns Boehme |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386672202 PECOS PAC ID: 1759384266 Enrollment ID: I20120202000590 |
| Provider Name | Sarah B Schiffres-grove |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194090555 PECOS PAC ID: 8224299003 Enrollment ID: I20120423000517 |
| Provider Name | Jenny C Mcfarland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578538310 PECOS PAC ID: 9638332455 Enrollment ID: I20120515000217 |
| Provider Name | Rena V Arnold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174808273 PECOS PAC ID: 1850554262 Enrollment ID: I20120523000065 |
| Provider Name | David Gonzalez-cawley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144295981 PECOS PAC ID: 9638333297 Enrollment ID: I20120611000374 |
| Provider Name | Lauree K Wolford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659623924 PECOS PAC ID: 3072768878 Enrollment ID: I20130228000226 |
| Provider Name | Robin D Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649554668 PECOS PAC ID: 0941435119 Enrollment ID: I20131023001510 |
| Provider Name | Jenna R Garner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174954028 PECOS PAC ID: 6709015001 Enrollment ID: I20140207001473 |
| Provider Name | Casey Crouch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811324395 PECOS PAC ID: 6709004534 Enrollment ID: I20140820000971 |
| Provider Name | Kathryn M Koons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902051030 PECOS PAC ID: 4880750967 Enrollment ID: I20150113001100 |
| Provider Name | James A Schiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932511714 PECOS PAC ID: 5193046217 Enrollment ID: I20150602000229 |
| Provider Name | Evan N Dickstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942688379 PECOS PAC ID: 2668773474 Enrollment ID: I20151221002534 |
| Provider Name | Anna K Elwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740679067 PECOS PAC ID: 1153614672 Enrollment ID: I20160721000824 |
| Provider Name | Amanda Bond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912381112 PECOS PAC ID: 9234424383 Enrollment ID: I20160829000914 |
| Provider Name | Kelly Anne Register-brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679890024 PECOS PAC ID: 0840598157 Enrollment ID: I20161006001700 |
| Provider Name | Jessie L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528436078 PECOS PAC ID: 7416237854 Enrollment ID: I20161201000711 |
| Provider Name | Jeanne Olson Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184964942 PECOS PAC ID: 7517105703 Enrollment ID: I20170225000281 |
| Provider Name | Michael P Shea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730195629 PECOS PAC ID: 9133378623 Enrollment ID: I20170926000141 |
| Provider Name | Kaitlin E Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932653086 PECOS PAC ID: 2668733056 Enrollment ID: I20180227002266 |
| Provider Name | Karla Rene Mcclain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104310291 PECOS PAC ID: 1355690611 Enrollment ID: I20180820001458 |
| Provider Name | Phoebe Antoinette Underwood-davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457844722 PECOS PAC ID: 6800148123 Enrollment ID: I20181015000317 |
| Provider Name | Debra Ambrose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518193416 PECOS PAC ID: 5991858615 Enrollment ID: I20190522003014 |
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