Provider Demographics
NPI:1881126019
Name:ELMAHDI, ANAS
Entity type:Individual
Prefix:DR
First Name:ANAS
Middle Name:
Last Name:ELMAHDI
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 1:5205 SWEETBRIAR C.
Mailing Address - Street 2:5205 SWEETBRIAR C.
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703
Mailing Address - Country:US
Mailing Address - Phone:757-483-1840
Mailing Address - Fax:
Practice Address - Street 1:5205 SWEETBRIAR C.
Practice Address - Street 2:5205 SWEETBRIAR C.
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-483-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist