Healthcare Provider Details

I. General information

NPI: 1447657150
Provider Name (Legal Business Name): SAMMY ELYAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMI ELYAS ALAWED MOHAMMED MD

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

IV. Provider business mailing address

120 N CEDAR ST APT 3816
CHARLOTTE NC
28202-1293
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-1111
  • Fax:
Mailing address:
  • Phone: 202-790-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016-00071
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: