Provider Demographics
NPI:1184679029
Name:ELSARRAG, ZAKI M (MD)
Entity Type:Individual
Prefix:
First Name:ZAKI
Middle Name:M
Last Name:ELSARRAG
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:3 E BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2705
Practice Address - Country:US
Practice Address - Phone:304-455-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057267207R00000X, 207P00000X
WV17865207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11101163OtherCAQH
VA010275610Medicaid
WV007503000Medicaid
WV00601919OtherBLUE CROSS BLUE SHIELD
WV1042794OtherBRICKSTREET
P00336893OtherRR MEDICARE BLUEFIELD
EL0770398Medicare PIN
WV007503000Medicaid