Provider Demographics
NPI:1235777210
Name:PROGRESSIVE NEUROLOGY LLC
Entity Type:Organization
Organization Name:PROGRESSIVE NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-799-7588
Mailing Address - Street 1:2405 WHITTIER DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3361
Mailing Address - Country:US
Mailing Address - Phone:301-799-7588
Mailing Address - Fax:301-799-7589
Practice Address - Street 1:2405 WHITTIER DR UNIT 100
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3361
Practice Address - Country:US
Practice Address - Phone:301-682-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty