1699232041 NPI number — EHAB KHAMIS ELHEFNAWI MD

Table of content: EHAB KHAMIS ELHEFNAWI MD (NPI 1699232041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699232041 NPI number — EHAB KHAMIS ELHEFNAWI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELHEFNAWI
Provider First Name:
EHAB
Provider Middle Name:
KHAMIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELHIFNAWY
Provider Other First Name:
EHAB
Provider Other Middle Name:
KHAMIS ELSAID AHMED
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699232041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER
Provider Second Line Business Mailing Address:
43 WHITING HILL ROAD, STE. 300
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-5035
Provider Business Mailing Address Fax Number:
207-973-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12222 MERIT DR STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-715-5000
Provider Business Practice Location Address Fax Number:
972-715-9976
Provider Enumeration Date:
02/21/2019

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: 207L00000X , with the licence number:  MD16212 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: T5106 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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