Provider Demographics
NPI:1942249735
Name:ELKHAIRI, DALIA S (MD)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:S
Last Name:ELKHAIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HEALTHY PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7067
Mailing Address - Country:US
Mailing Address - Phone:740-348-1920
Mailing Address - Fax:740-348-1921
Practice Address - Street 1:1 HEALTHY PL
Practice Address - Street 2:SUITE 201
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7067
Practice Address - Country:US
Practice Address - Phone:740-348-1920
Practice Address - Fax:740-348-1921
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38967207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2254813Medicaid
KY64084569Medicaid
OH4054324Medicare PIN
OH2254813Medicaid
KY64084569Medicaid