Provider Demographics
NPI:1760461859
Name:ELMEDKHAR, MHAIDI (MD)
Entity Type:Individual
Prefix:
First Name:MHAIDI
Middle Name:
Last Name:ELMEDKHAR
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 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1449
Practice Address - Country:US
Practice Address - Phone:302-376-6761
Practice Address - Fax:302-376-6765
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE490381Medicare PIN