Basic Information
| Provider Information | |||||||||
| NPI: | 1760715403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINCHESTER PSYCHIATRIC ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2842 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226042042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047883415 | ||||||||
| FaxNumber: | 3047884561 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 SOUTHERN DR | ||||||||
| Address2: | |||||||||
| City: | KEYSER | ||||||||
| State: | WV | ||||||||
| PostalCode: | 267262010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047883415 | ||||||||
| FaxNumber: | 3047884561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | ABASSI | ||||||||
| AuthorizedOfficialFirstName: | IMRAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3047883415 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 23738 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | DP6932 | 01 | WV | MEDICARE RR | OTHER |