| Bowie Town Behavioral Services, Inc | |
|
3060 Mitchellville Rd Suite 104 Bowie MD 20716-1389 | |
| (301) 218-4220 | |
| (301) 218-4330 |
| Full Name | Bowie Town Behavioral Services, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3060 Mitchellville Rd, Bowie, Maryland |
| Authorized Official Name and Position | Dida K. Ganjoo (OWNER) |
| Authorized Official Contact | 3012184220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bowie Town Behavioral Services, Inc 3060 Mitchellville Rd Suite 104 Bowie MD 20716-1389 Ph: (301) 218-4220 | Bowie Town Behavioral Services, Inc 3060 Mitchellville Rd Suite 104 Bowie MD 20716-1389 Ph: (301) 218-4220 |
| NPI Number | 1154340362 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 01/09/2012 |
| Medicare PECOS PAC ID | 8224203468 |
|---|---|
| Medicare Enrollment ID | O20111216000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154340362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | D0036532 (Maryland) | Primary |
| Provider Name | Dida K Ganjoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265451470 PECOS PAC ID: 4688611874 Enrollment ID: I20070601000350 |
| Provider Name | Rajan Sood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801873898 PECOS PAC ID: 3375592124 Enrollment ID: I20080616000792 |
| Provider Name | Lakshya Nair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831513274 PECOS PAC ID: 1456576461 Enrollment ID: I20140708001055 |
| Provider Name | Kumutha F Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225627136 PECOS PAC ID: 3173932670 Enrollment ID: I20210513002188 |
| Provider Name | Beserat Legesse Kibret |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578139689 PECOS PAC ID: 9234526120 Enrollment ID: I20220422002197 |
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