Provider Demographics
NPI:1417130253
Name:MAPLEWOOD PSYCHIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:MAPLEWOOD PSYCHIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-2424
Mailing Address - Street 1:2830 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4100
Mailing Address - Country:US
Mailing Address - Phone:336-768-2424
Mailing Address - Fax:336-768-1857
Practice Address - Street 1:2830 MAPLEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4100
Practice Address - Country:US
Practice Address - Phone:336-768-2424
Practice Address - Fax:336-768-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-16
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16722174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945827Medicaid
NC45827OtherBLUE CROSS BLUE SHIELD
NC45827OtherBLUE CROSS BLUE SHIELD
NCC85181Medicare UPIN