Provider Demographics
NPI:1154657716
Name:ELAHI, FOAD (MD)
Entity Type:Individual
Prefix:
First Name:FOAD
Middle Name:
Last Name:ELAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 NORMAN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5925
Mailing Address - Country:US
Mailing Address - Phone:209-824-4400
Mailing Address - Fax:209-824-4420
Practice Address - Street 1:1144 NORMAN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5925
Practice Address - Country:US
Practice Address - Phone:209-824-4400
Practice Address - Fax:209-824-4420
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY253352081P2900X
IL036126105208VP0000X
IA39467208100000X, 2081P2900X
CAA1062792081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation