Provider Demographics
NPI:1427794106
Name:MIND MD
Entity type:Organization
Organization Name:MIND MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-283-1468
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-1292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15221 CARROLLTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2325
Practice Address - Country:US
Practice Address - Phone:757-922-3085
Practice Address - Fax:866-362-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11375291OtherCOMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION