Healthcare Provider Details

I. General information

NPI: 1912166430
Provider Name (Legal Business Name): ADVANCED NEUROLOGY AND SLEEP CENTER OF FREDERICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/20/2013
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 Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberH0065700
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberH0065700
License Number StateMD

VIII. Authorized Official

Name: DR. SALAM ZUGHAYER
Title or Position: PRESIDENT
Credential: DO
Phone: 301-367-9771