Provider Demographics
NPI:1942927850
Name:KHOURY, ELIAS MELAD
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:MELAD
Last Name:KHOURY
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 1:601 47TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1821
Mailing Address - Country:US
Mailing Address - Phone:304-617-3850
Mailing Address - Fax:
Practice Address - Street 1:601 47TH ST SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1821
Practice Address - Country:US
Practice Address - Phone:304-617-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant