Provider Demographics
NPI:1992186027
Name:ELIAN, MAYADA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYADA
Middle Name:
Last Name:ELIAN
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 1:106 MARTINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-8304
Mailing Address - Country:US
Mailing Address - Phone:202-809-5042
Mailing Address - Fax:
Practice Address - Street 1:3504 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-0737
Practice Address - Fax:606-248-0739
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine