Healthcare Provider Details

I. General information

NPI: 1740698679
Provider Name (Legal Business Name): FAYSAL M ELGILANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

IV. Provider business mailing address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-7180
  • Fax: 207-662-7190
Mailing address:
  • Phone: 207-662-7180
  • Fax: 207-662-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD26343
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD26343
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: