Neuroservice of Maryland PC

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

Legal business name

NEUROSERVICE OF MARYLAND PC

Practice address

325 Ellington Blvd
PMB #454
Gaithersburg, MD 20878-4591

Phone

(240) 224-9504

NPI assigned

Apr 21, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Raley, M.D.

Title

President

Phone

(240) 224-9504

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1639604168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 ELLINGTON BLVD",
            "address_2": "PMB #454",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208784591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ELLINGTON BLVD",
            "address_2": "PMB #454",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208784591",
            "telephone_number": "240-224-9504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSERVICE OF MARYLAND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "RALEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "240-224-9504",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.