Healthcare Provider Details

I. General information

NPI: 1538348156
Provider Name (Legal Business Name): KEY NEUROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 THOMAS JOHNSON DR SUITE 100
FREDERICK MD
21702-4423
US

IV. Provider business mailing address

174 THOMAS JOHNSON DR SUITE 100
FREDERICK MD
21702-4423
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9380
  • Fax: 301-668-9480
Mailing address:
  • Phone: 301-668-9380
  • Fax: 301-668-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH0065700
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberH0065700
License Number StateMD

VIII. Authorized Official

Name: DR. SALAM ZUGHAYER
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 301-367-9771