| Loudoun Psychiatric Associates, Pc | |
|
44790 Maynard Sq Ste 130 Ashburn VA 20147-6514 | |
| (703) 542-3737 | |
| (703) 584-7378 |
| Full Name | Loudoun Psychiatric Associates, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 44790 Maynard Sq Ste 130, Ashburn, Virginia |
| Authorized Official Name and Position | Imran Abassi (OWNER) |
| Authorized Official Contact | 7035423737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loudoun Psychiatric Associates, Pc 44790 Maynard Sq Ste 130 Ashburn VA 20147-6514 Ph: (703) 542-3737 | Loudoun Psychiatric Associates, Pc 44790 Maynard Sq Ste 130 Ashburn VA 20147-6514 Ph: (703) 542-3737 |
| NPI Number | 1760715403 |
|---|---|
| Provider Enumeration Date | 09/14/2009 |
| Last Update Date | 04/13/2023 |
| Certification Date | 04/13/2023 |
| Medicare PECOS PAC ID | 9739225939 |
|---|---|
| Medicare Enrollment ID | O20091001000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760715403 | NPI | - | NPPES |
| DP6932 | Other | WV | MEDICARE RR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 23738 (West Virginia) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Imran M Abassi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003875014 PECOS PAC ID: 3274629522 Enrollment ID: I20091001000066 |
| Provider Name | Samira Siddiq Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013336031 PECOS PAC ID: 2668706169 Enrollment ID: I20190702002401 |
| Provider Name | Brenda J Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730333964 PECOS PAC ID: 0143385039 Enrollment ID: I20220930000246 |
| Provider Name | Matthew Greeley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013618057 PECOS PAC ID: 7911368451 Enrollment ID: I20240321000174 |
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