Provider Demographics
NPI:1780646141
Name:SAFI, ELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAM
Middle Name:
Last Name:SAFI
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 1:83 SOUTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-1660
Mailing Address - Country:US
Mailing Address - Phone:413-967-5562
Mailing Address - Fax:
Practice Address - Street 1:83 SOUTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1660
Practice Address - Country:US
Practice Address - Phone:413-967-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3183645Medicaid
MA3183645Medicaid