Provider Demographics
NPI:1972976819
Name:ELSHAZLI, RHAMMI (OD)
Entity Type:Individual
Prefix:DR
First Name:RHAMMI
Middle Name:
Last Name:ELSHAZLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 ACTON LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3689
Mailing Address - Country:US
Mailing Address - Phone:240-435-4822
Mailing Address - Fax:904-207-7933
Practice Address - Street 1:11930 ACTON LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3689
Practice Address - Country:US
Practice Address - Phone:240-435-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00664200152W00000X
NYTUV008377-1152W00000X
MDTA2504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist