Provider Demographics
NPI:1962501718
Name:ELDALY, MOHAMED E (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:E
Last Name:ELDALY
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 1:6121 N THESTA ST
Mailing Address - Street 2:204
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-438-7390
Mailing Address - Fax:559-438-7166
Practice Address - Street 1:880 E TUOLUMNE RD
Practice Address - Street 2:103
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1548
Practice Address - Country:US
Practice Address - Phone:209-669-8300
Practice Address - Fax:209-669-9300
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75069207R00000X
CAC52285207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C522850Medicaid
CA00C522850OtherBLUE SHIELD
CAGR0103970Medicaid
CA00C522850OtherBLUE SHIELD
CA00C522850Medicaid
P00435882Medicare PIN