Provider Demographics
NPI:1467418905
Name:EL-TARABILY, MOHAMED EL-SAYED (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:EL-SAYED
Last Name:EL-TARABILY
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 1:310 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3126
Mailing Address - Country:US
Mailing Address - Phone:307-634-9311
Mailing Address - Fax:
Practice Address - Street 1:310 E 24TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3126
Practice Address - Country:US
Practice Address - Phone:307-634-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7809A207RH0000X, 207RH0003X
ORMD23076207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287418Medicaid
H47490Medicare UPIN
OR287418Medicaid