Provider Demographics
NPI:1578530457
Name:ELRAIE, KHALED FOUAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:FOUAD
Last Name:ELRAIE
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7042
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:SUITE 320
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-366-3715
Practice Address - Fax:843-366-3716
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20577207RG0100X
DEC1-0011172207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205771Medicaid
SC205771Medicaid
SC205771Medicaid