Provider Demographics
NPI:1386815371
Name:METROPOLITAN PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:METROPOLITAN PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:434-979-1902
Mailing Address - Street 1:295 RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:WINGINA
Mailing Address - State:VA
Mailing Address - Zip Code:24599-3083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 ARLINGTON BOULEVARD
Practice Address - Street 2:SUITE 130
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209
Practice Address - Country:US
Practice Address - Phone:434-979-1902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010199222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01804Medicare PIN