Organization
EASTERN PANHANDLE PSYCHIATRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHNOOR ALI KHAN MD (PRESIDENT)
(703) 400-3433
Entity
Organization
Contact information
Practice address
51 STREET OF DREAMS, MARTINSBURG, WV 25403-1134
(304) 264-1442
(304) 264-4317
Mailing address
PO BOX 4056, MARTINSBURG, WV 25402-4056
(304) 264-1442
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20620
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346342458
INDIVIDUAL NPI
WV
05
—
2000700000
—
WV
01
—
20620
WV LICENSE
WV
01
—
D0064888
MD LICENSE
MD
Enumeration date
10/25/2006
Last updated
03/07/2023
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