Healthcare Provider Details

I. General information

NPI: 1710166095
Provider Name (Legal Business Name): ELHAM AFGHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST # 465
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

530 S JACKSON ST
LOUISVILLE KY
40202-1675
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9697
  • Fax: 410-614-7340
Mailing address:
  • Phone: 502-852-5851
  • Fax: 502-852-6056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD200001388
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD86625
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA 107262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: