Organization
INNOVATIVE PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANANDRAJ MATTAI MD (OWNER)
(443) 542-0773
Entity
Organization
Contact information
Practice address
8850 COLUMBIA 100 PKWY, SUITE 403, COLUMBIA, MD 21045-2374
(443) 542-0773
(443) 542-0931
Mailing address
8850 COLUMBIA 100 PKWY, SUITE 403, COLUMBIA, MD 21045-2374
(443) 542-0773
(443) 542-0931
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D67668
MD
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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