Provider Demographics
NPI:1508566811
Name:WAVERLY PSYCHIATRY LLC
Entity Type:Organization
Organization Name:WAVERLY PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ASAD HASSAN
Authorized Official - Last Name:BOKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-988-8083
Mailing Address - Street 1:10709 BIRMINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1403
Mailing Address - Country:US
Mailing Address - Phone:410-988-8083
Mailing Address - Fax:833-909-0051
Practice Address - Street 1:10709 BIRMINGHAM WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1403
Practice Address - Country:US
Practice Address - Phone:410-988-8083
Practice Address - Fax:833-909-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty