Provider Demographics
NPI:1710146709
Name:ALI-ELTOM, MOHAMED MURTADA
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:MURTADA
Last Name:ALI-ELTOM
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 1:5765 READING AVE APT 62
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2139 GEORGIA AVE NW STE 3B
Practice Address - Street 2:2139 GEORGIA AVENUE, NW, SUITE #3B, WASHINGTON, DC 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3006
Practice Address - Country:US
Practice Address - Phone:202-865-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-0303232084N0400X
NC2020-03023208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology