Healthcare Provider Details

I. General information

NPI: 1992780084
Provider Name (Legal Business Name): NAHEL ELIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WHITE 546
BOSTON MA
02114-2696
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-0174
  • Fax: 617-724-5993
Mailing address:
  • Phone: 617-726-0174
  • Fax: 617-724-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number213765
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number042.0012767
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: