Provider Demographics
NPI:1386719128
Name:WINSTON PSYCHIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:WINSTON PSYCHIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJAKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THOTAKURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-6577
Mailing Address - Street 1:125 ASHLEYBROOK SQUARE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-6577
Mailing Address - Fax:336-768-2972
Practice Address - Street 1:125 ASHLEYBROOK SQUARE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-765-6577
Practice Address - Fax:336-768-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0299KOtherBCBS
NC890299KMedicaid
NC890299KMedicaid