Provider Demographics
NPI:1639386899
Name:ELFAKI, MOHAMED AHMED E
Entity Type:Individual
Prefix:MR
First Name:MOHAMED AHMED
Middle Name:E
Last Name:ELFAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 HARWICH CT
Mailing Address - Street 2:222
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5741
Mailing Address - Country:US
Mailing Address - Phone:202-369-2205
Mailing Address - Fax:703-933-9494
Practice Address - Street 1:5741 HARWICH CT
Practice Address - Street 2:222
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-5741
Practice Address - Country:US
Practice Address - Phone:202-369-2205
Practice Address - Fax:703-933-9494
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC742343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)