Provider Demographics
NPI:1689281529
Name:PREMIER PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:PREMIER PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MODISETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-742-9167
Mailing Address - Street 1:10601 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2315
Mailing Address - Country:US
Mailing Address - Phone:443-742-9167
Mailing Address - Fax:
Practice Address - Street 1:10601 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2315
Practice Address - Country:US
Practice Address - Phone:443-353-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty