Provider Demographics
NPI:1326304288
Name:INTERSTATE PSYCHAITRIC CARE
Entity Type:Organization
Organization Name:INTERSTATE PSYCHAITRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-575-0083
Mailing Address - Street 1:20526 WILDERNESS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1865
Mailing Address - Country:US
Mailing Address - Phone:609-575-0083
Mailing Address - Fax:301-790-0936
Practice Address - Street 1:324 E ANTIETAM ST
Practice Address - Street 2:SUITE 307-A
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5754
Practice Address - Country:US
Practice Address - Phone:609-575-0083
Practice Address - Fax:301-790-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM719952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid