Provider Demographics
NPI:1346463130
Name:ELABIAD, MOHAMAD TAMMAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:TAMMAM
Last Name:ELABIAD
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 1:5335 RAPPAHANNOCK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-6223
Mailing Address - Country:US
Mailing Address - Phone:901-340-7390
Mailing Address - Fax:
Practice Address - Street 1:UT COLLEGE OF MEDICINE
Practice Address - Street 2:920 MADISON AVENUE SUITE C50
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD419792080N0001X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165636001Medicaid
GA003179404AMedicaid
MS00970870Medicaid
MO1346463130Medicaid
MI1346463130Medicaid
AL178101Medicaid
TN5441966Medicaid