1801335989 NPI number — ANTHONY A. ELGOHARY, DMD, PLLC

Table of content: (NPI 1801335989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801335989 NPI number — ANTHONY A. ELGOHARY, DMD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY A. ELGOHARY, DMD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1801335989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5131 RIVER CLUB DR
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-484-4197
Provider Business Mailing Address Fax Number:
757-483-9065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5131 RIVER CLUB DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-484-4197
Provider Business Practice Location Address Fax Number:
757-483-9065
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RICKS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
757-484-4197

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401410824 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com