Provider Demographics
NPI:1023086782
Name:ELBACKUSH, MAHMUD R (MD)
Entity type:Individual
Prefix:
First Name:MAHMUD
Middle Name:R
Last Name:ELBACKUSH
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 1:7964 ARDEN CT
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1002
Mailing Address - Country:US
Mailing Address - Phone:703-573-8971
Mailing Address - Fax:703-573-8971
Practice Address - Street 1:7964 ARDEN CT
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1002
Practice Address - Country:US
Practice Address - Phone:703-573-8971
Practice Address - Fax:703-573-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057944207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H36987Medicare UPIN