Provider Demographics
NPI:1245253673
Name:CRESCENT PSYCHIATRIC SERVICES, P.C.
Entity type:Organization
Organization Name:CRESCENT PSYCHIATRIC SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YASIN
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-474-1010
Mailing Address - Street 1:2124 RIDING CROP WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1287
Mailing Address - Country:US
Mailing Address - Phone:443-474-1010
Mailing Address - Fax:
Practice Address - Street 1:2124 RIDING CROP WAY
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1287
Practice Address - Country:US
Practice Address - Phone:443-474-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD749MMedicare ID - Type UnspecifiedGROUP PROVIDER