Healthcare Provider Details

I. General information

NPI: 1386578094
Provider Name (Legal Business Name): MOHAMED E ELAKSHAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 NICHOLS RD
FITCHBURG MA
01420-1914
US

IV. Provider business mailing address

40 GOODRICH ST
LUNENBURG MA
01462-1610
US

V. Phone/Fax

Practice location:
  • Phone: 347-761-9161
  • Fax:
Mailing address:
  • Phone: 347-761-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: