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General NPI Number Information
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NPI Number | 1750710141
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CENTER OF EXCELLENCE
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 1004 TAVERN RD
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City | MARTINSBURG
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State | WV
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Zip | 25401-2864
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Country | US
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Telephone | 301-675-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 TAVERN RD
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City | MARTINSBURG
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State | WV
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Zip | 25401-2864
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Country | US
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Telephone | 301-675-5301
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR/MANAGER
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Name | DR. EDUARDO DANIEL ZAMORA
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Credential | M.D.
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Telephone | 301-675-5301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 24966
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License Number State | WV
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