Provider Demographics
NPI:1033398755
Name:MARYLAND INSTITUTE OF NEUROLGICAL DISORDERS AND SLEEP, P.A.
Entity Type:Organization
Organization Name:MARYLAND INSTITUTE OF NEUROLGICAL DISORDERS AND SLEEP, P.A.
Other - Org Name:DUGHLY AND ASSOCIATE, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OF M.I.N.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:EYAD
Authorized Official - Last Name:DUGHLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-761-3900
Mailing Address - Street 1:325 HOSPITAL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5860
Mailing Address - Country:US
Mailing Address - Phone:410-761-3900
Mailing Address - Fax:
Practice Address - Street 1:325 HOSPITAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5860
Practice Address - Country:US
Practice Address - Phone:410-761-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD531982000Medicaid
MD531982000Medicaid
MD953MMedicare PIN