Provider Demographics
NPI:1295289080
Name:ELGAALI, AZHARI
Entity type:Individual
Prefix:
First Name:AZHARI
Middle Name:
Last Name:ELGAALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 CLOISTERS E
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4522
Mailing Address - Country:US
Mailing Address - Phone:804-248-4268
Mailing Address - Fax:
Practice Address - Street 1:9001 CLOISTERS E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4522
Practice Address - Country:US
Practice Address - Phone:804-248-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT63626896343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)