Healthcare Provider Details

I. General information

NPI: 1598741191
Provider Name (Legal Business Name): BRAHIM ELOUARDIGHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CARROLL AVE
TAKOMA PARK MD
20912-6367
US

IV. Provider business mailing address

7600 CARROLL AVE
TAKOMA PARK MD
20912-6367
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLT 12563
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101236263
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101236263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: