1568049245 NPI number — DR. ABUBAKER KHALAFALLA MOHAMED ELEMAM MBBS

Table of content: DR. ABUBAKER KHALAFALLA MOHAMED ELEMAM MBBS (NPI 1568049245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568049245 NPI number — DR. ABUBAKER KHALAFALLA MOHAMED ELEMAM MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELEMAM
Provider First Name:
ABUBAKER
Provider Middle Name:
KHALAFALLA MOHAMED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568049245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1959 NE PACIFIC STREET BOX 357115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-598-2094
Provider Business Mailing Address Fax Number:
206-543-6317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-598-2094
Provider Business Practice Location Address Fax Number:
206-543-6317
Provider Enumeration Date:
03/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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