Healthcare Provider Details

I. General information

NPI: 1780702985
Provider Name (Legal Business Name): GARY GLEN KAY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MASSACHUSETTS AVE NW SUITE 240
WASHINGTON DC
20016-4358
US

IV. Provider business mailing address

4900 MASSACHUSETTS AVE NW SUITE 240
WASHINGTON DC
20016-4358
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-7520
  • Fax:
Mailing address:
  • Phone: 202-686-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1384
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: