Provider Demographics
NPI:1225057276
Name:ISMAIL, ELHAM M (MD)
Entity Type:Individual
Prefix:
First Name:ELHAM
Middle Name:M
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S LAUREL ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1946
Mailing Address - Country:US
Mailing Address - Phone:856-451-4700
Mailing Address - Fax:856-863-5732
Practice Address - Street 1:70 COHANSEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1918
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-863-5732
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2267101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY172369822Medicaid
133AG10Medicare ID - Type Unspecified
NY172369822Medicaid