NPIMap

Organization Active NPI

Bowie Town Behavioral Services, Inc

  • Psychiatry Physician
  • Bowie, MD
National Provider Identifier
1154340362
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
D0036532 Issued in MD
Legal business name
BOWIE TOWN BEHAVIORAL SERVICES, INC
Practice address
3060 Mitchellville Rd
Suite 104
Bowie, MD 20716-1389
Phone
(301) 218-4220
Fax
(301) 218-4330
NPI assigned
Jul 19, 2006
Last updated
Jan 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dida K. Ganjoo, M.D.NPI 1265451470
Title
Owner
Phone
(301) 218-4220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X D0036532 MD Primary

Addresses

Primary practice location

3060 Mitchellville Rd
Suite 104
Bowie, MD 20716-1389

Mailing address

3060 Mitchellville Rd
Suite 104
Bowie, MD 20716-1389
Phone (301) 218-4220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111216000051 DC Part B Supplier - Clinic/Group Practice 8224203468 Receives reassigned benefits from 5 practitioners
Practice locations: Forestville, MD; Silver Spring, MD; Bowie, MD

National Provider Directory

National Provider Directory

Locations

831 University Blvd E
Ste 26
Silver Spring, MD 20903
Phone (240) 641-8305

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326067200000",
    "number": "1154340362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 MITCHELLVILLE RD",
            "address_2": "SUITE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161389",
            "telephone_number": "301-218-4220",
            "fax_number": "301-218-4330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 MITCHELLVILLE RD",
            "address_2": "SUITE 104",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161389",
            "telephone_number": "301-218-4220",
            "fax_number": "301-218-4330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWIE TOWN BEHAVIORAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-01-09",
        "status": "A",
        "authorized_official_last_name": "GANJOO",
        "authorized_official_first_name": "DIDA",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-218-4220",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D0036532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.