Provider Demographics
NPI:1003111238
Name:ADVANCED TELEPSYCHIATRY, INC.
Entity Type:Organization
Organization Name:ADVANCED TELEPSYCHIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PARAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-772-1974
Mailing Address - Street 1:5372 FALLOWATER LANE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-772-1974
Mailing Address - Fax:540-283-0032
Practice Address - Street 1:5372 FALLOWATER LANE
Practice Address - Street 2:SUITE C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-772-1974
Practice Address - Fax:540-283-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty