Provider Demographics
NPI:1255099545
Name:MAGELLAN PROVIDER SERVICES, P.A.
Entity type:Organization
Organization Name:MAGELLAN PROVIDER SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAO
Authorized Official - Middle Name:HARIS
Authorized Official - Last Name:NASEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-565-0800
Mailing Address - Street 1:8621 ROBERT FULTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6303 COWBOYS WAY STE 350
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0335
Practice Address - Country:US
Practice Address - Phone:866-605-0634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty