Healthcare Provider Details

I. General information

NPI: 1780646141
Provider Name (Legal Business Name): ELAM SAFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SOUTH ST SUITE 2
WARE MA
01082-1660
US

IV. Provider business mailing address

83 SOUTH ST SUITE 2
WARE MA
01082-1660
US

V. Phone/Fax

Practice location:
  • Phone: 413-967-5562
  • Fax:
Mailing address:
  • Phone: 413-967-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number156847
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: