Provider Demographics
NPI:1518151620
Name:ELSANJAK, ABDELAZIZ ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDELAZIZ
Middle Name:ALI
Last Name:ELSANJAK
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 1:2602 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1010
Mailing Address - Country:US
Mailing Address - Phone:540-344-1400
Mailing Address - Fax:540-344-7133
Practice Address - Street 1:2602 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1010
Practice Address - Country:US
Practice Address - Phone:540-344-1400
Practice Address - Fax:540-344-7133
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56665207R00000X
VA0101242405207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518151620OtherANTHEM
VA1518151620Medicaid
3408259OtherCIGNA
1518151620OtherUNITED HEALTHCARE
3408259OtherCIGNA
VA1518151620Medicaid