Provider Demographics
NPI:1154340362
Name:BOWIE TOWN BEHAVIORAL SERVICES, INC
Entity type:Organization
Organization Name:BOWIE TOWN BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANJOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-218-4220
Mailing Address - Street 1:3060 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1389
Mailing Address - Country:US
Mailing Address - Phone:301-218-4220
Mailing Address - Fax:301-218-4330
Practice Address - Street 1:3060 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1389
Practice Address - Country:US
Practice Address - Phone:301-218-4220
Practice Address - Fax:301-218-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00365322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty