Provider Demographics
NPI:1235255290
Name:EL MAHDY, SHERIF OMAR (MD)
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:OMAR
Last Name:EL MAHDY
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 1:600 GRESHAM DR
Mailing Address - Street 2:SUITE 8630
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6115
Mailing Address - Fax:757-388-6116
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:SUITE 8630
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-388-6115
Practice Address - Fax:757-388-6116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND11374207RP1001X
MI4301075357207RP1001X
IA36458207RP1001X
VA0101237850207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1235255290Medicaid
IA71926032Medicare PIN
IA1235255290Medicaid
I43680Medicare UPIN
IA156160005Medicare PIN