Provider Demographics
NPI:1750910857
Name:INNOVATIVE TMS LLC
Entity type:Organization
Organization Name:INNOVATIVE TMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANDRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-542-0773
Mailing Address - Street 1:9256 BENDIX RD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1848
Mailing Address - Country:US
Mailing Address - Phone:319-331-3653
Mailing Address - Fax:443-542-0931
Practice Address - Street 1:9256 BENDIX RD STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1848
Practice Address - Country:US
Practice Address - Phone:443-542-0773
Practice Address - Fax:443-542-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty