Provider Demographics
NPI:1730646290
Name:HAGERSTOWN PSYCHIATRY INC
Entity Type:Organization
Organization Name:HAGERSTOWN PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-400-3433
Mailing Address - Street 1:11123 COROBON LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1403
Mailing Address - Country:US
Mailing Address - Phone:304-279-9772
Mailing Address - Fax:703-763-2350
Practice Address - Street 1:12821 OAK HILL AVE STE 3
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2959
Practice Address - Country:US
Practice Address - Phone:240-452-1623
Practice Address - Fax:240-597-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0064888OtherSTATE MEDICAL LICENSE