MR. EVAN NATHAN DICKSTEIN (NPI# 1942688379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1942688379 |
Entity Type | Individual |
Full Name | MR. EVAN NATHAN DICKSTEIN |
Credential | NP-PMH |
Practice Address |
5301 Buckeystown Pike Frederick MD 21704-8370 |
Mailing Address |
13121 Brook Lane Hagerstown MD 21742-1945 |
Practice Telephone | 3017330330 |
Practice Fax Number | 3017334038 |
Mailing Telephone | 3017330330 |
Mailing Fax Number | 3017334038 |
Enumeration Date | 2015-05-18 |
Last Update Date | 2018-02-15 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163W00000X | Registered Nurse | R200789 | MD | Nursing Service Providers |
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R200789 | MD | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
5301 BUCKEYSTOWN PIKE |
City | FREDERICK |
State | MD |
Zip Code | 21704-8370 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972584233 | Andrew B. Johnson | Psychiatry & Neurology | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2005-11-14 |
1366093098 | Shannon Snowman | Student in an Organized Health Care Education/Training Program | 5301 Buckeystown Pike, Stet 170, Frederick, MD 21704 | 2019-09-24 |
1538657630 | Brook Lane Behavioral Services, Inc. | Clinic/Center | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2018-04-25 |
1649624198 | Mary Noble | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-21 |
1558715185 | Melissa Crigger | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-20 |
1174986558 | Marta Menendez-voss | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2016-04-01 |
1962890962 | Emily Collingham | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-12-30 |
1518361690 | Maria Murphy | Counselor | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-10-17 |
1932511714 | James Arthur Schiller | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-05-28 |
1952729568 | Samantha Elizabeth Wilt | Social Worker | 5301 Buckeystown Pike, Frederick, MD 21704-8370 | 2014-04-01 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144747148 | Danah Jack | Physical Therapist | 4070 Atterbury Place, Frederick, MD 21704 | 2017-08-29 |
1568986891 | Amy Benjamin Slp | Speech-Language Pathologist | 8905 Amelung St, Frederick, MD 21704 | 2017-07-28 |
1104352368 | Mentor-maryland | Community/Behavioral Health | 5970 Frederick Crossing Lane, #202, Frederick, MD 21704 | 2017-05-10 |
1699193284 | Jiang Tan | Acupuncturist | 3520 Worthington Blvd #101, Frederick, MD 21704 | 2014-04-01 |
1326460817 | Jessica Lacayo | Nurse Practitioner | 3350 Worthington Boulevard, Urbana, MD 21704 | 2014-01-17 |
1588098818 | Kimberly Kaye Dipietro | Registered Nurse | 9006 Harris Street, Frederick, MD 21704 | 2013-08-22 |
1831432525 | Yuqing Meng | Pharmacist | 9317 Elgin Lane, Frederick, MD 21704 | 2013-04-01 |
1831446285 | Diane Marie Foland | Behavioral Analyst | 4235 Lafayette Street, Frederick, MD 21704 | 2012-08-03 |
1982932695 | Contemporary Therapeutic Services Inc | Community/Behavioral Health | 22 N Potomac Street, Ste 102, Hagerstown, MD 21704 | 2009-11-19 |
1942461181 | Hoa T K Lam | Dentist | 7360 Guilford Drive, Suite #102, Frederick, MD 21704 | 2008-06-20 |
Find all providers in zip 21704 |
Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821560525 | Titus Koimur | Nurse Practitioner | 107 Bierstadt Ct, Frederick, MD 21702-6442 | 2018-12-19 |
1508338203 | Joel Griffith | Nurse Practitioner | 251 W Patrick St, Frederick, MD 21701-6942 | 2018-12-19 |
1831610161 | William Haynes | Nurse Practitioner | 103 Water Land Ct., Frederick, MD 21702 | 2017-06-27 |
1235672205 | Julie Ann Dagenhart | Nurse Practitioner | 1003 W 7th St Ste 403, Frederick, MD 21701-8532 | 2016-11-23 |
1689286197 | Kelly Amike Ngenge | Nurse Practitioner | 107 Bierstadt Ct, Frederick, MD 21702-6442 | 2020-08-18 |
1477197424 | Jaclyn Blaire Daugherty | Nurse Practitioner | 604 Solarex Ct Unit 201, Frederick, MD 21703-8655 | 2019-11-03 |
1386298768 | Molly Kathryn Aitken | Nurse Practitioner | 1003 W 7th St Ste 403, Frederick, MD 21701-8532 | 2019-07-24 |
1457844722 | Phoebe Antoinette Underwood-davis | Nurse Practitioner | 5301 Buckeystown Pike Ste 170, Frederick, MD 21704 | 2018-06-12 |
1730677121 | Michelle Lynn Ridgeway | Nurse Practitioner | 400 W 7th St, Frederick, MD 21701 | 2018-05-01 |
1295270445 | Carolyn Calleo | Nurse Practitioner | 604 Solarex Ct, Suite 201, Frederick, MD 21703-7005 | 2016-12-27 |
Find all providers in FREDERICK |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.