Healthcare Provider Details

I. General information

NPI: 1578530457
Provider Name (Legal Business Name): KHALED FOUAD ELRAIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E SUITE 320
LITTLE RIVER SC
29566-8163
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-3715
  • Fax: 843-366-3716
Mailing address:
  • Phone: 843-777-7042
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME148173
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC1-0011172
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20577
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: