Provider Demographics
NPI:1821115064
Name:TEHRANCHI, ELAHEH N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAHEH
Middle Name:N
Last Name:TEHRANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAHEHNAZ
Other - Middle Name:
Other - Last Name:TEHRANCHIZADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 873010
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3010
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1743
Practice Address - Street 1:2525 NE 139TH ST STE 230
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1777
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60714215207R00000X
NV12761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002281Medicaid