NPIMap

Organization Active NPI

Innovative Psychiatry LLC

  • Psychiatry Physician
  • Columbia, MD
National Provider Identifier
1215398334
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
D67668 Issued in MD
Legal business name
INNOVATIVE PSYCHIATRY LLC
Practice address
8850 Columbia 100 Pkwy
Suite 403
Columbia, MD 21045-2374
Phone
(443) 542-0773
Fax
(443) 542-0931
NPI assigned
Mar 17, 2016
Last updated
Mar 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Anandraj Mattai, MDNPI 1407070881
Title
Owner
Phone
(443) 542-0773

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 D67668 MD Primary

Addresses

Primary practice location

8850 Columbia 100 Pkwy
Suite 403
Columbia, MD 21045-2374

Mailing address

8850 Columbia 100 Pkwy
Suite 403
Columbia, MD 21045-2374
Phone (443) 542-0773

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1215398334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8850 COLUMBIA 100 PKWY",
            "address_2": "SUITE 403",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452374",
            "telephone_number": "443-542-0773",
            "fax_number": "443-542-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8850 COLUMBIA 100 PKWY",
            "address_2": "SUITE 403",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452374",
            "telephone_number": "443-542-0773",
            "fax_number": "443-542-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "MATTAI",
        "authorized_official_first_name": "ANANDRAJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-542-0773",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D67668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.