Provider Demographics
NPI:1003260407
Name:BALAKHANLOU, ELNAZ (MD)
Entity type:Individual
Prefix:DR
First Name:ELNAZ
Middle Name:
Last Name:BALAKHANLOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:BALAKHANLOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:820 W DIAMOND AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 W DIAMOND AVE STE 400
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1469
Practice Address - Country:US
Practice Address - Phone:301-315-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263166208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation