Healthcare Provider Details

I. General information

NPI: 1124479811
Provider Name (Legal Business Name): RADOWAN ALI MAHGOUB ELNAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-6565
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax: 507-266-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD19360
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD19360
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: