Provider Demographics
NPI:1487822391
Name:ELANGO, MBOH E (MD)
Entity Type:Individual
Prefix:DR
First Name:MBOH
Middle Name:E
Last Name:ELANGO
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 1:1195 MILTON TER SE APT 2201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-2428
Mailing Address - Country:US
Mailing Address - Phone:678-778-6983
Mailing Address - Fax:
Practice Address - Street 1:1039 GRANT ST SE STE D12
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2014
Practice Address - Country:US
Practice Address - Phone:678-736-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine