Healthcare Provider Details

I. General information

NPI: 1013179654
Provider Name (Legal Business Name): KHALID ABDELSALAM ELNAGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 JOHNS HOPKINS DR ECU PHYSICIANS PSYCHIATRIC OUTPATIENT CENTER
GREENVILLE NC
27834-2056
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-1406
  • Fax: 252-744-4243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number262343
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2015-01748
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: