Healthcare Provider Details

I. General information

NPI: 1235255290
Provider Name (Legal Business Name): SHERIF OMAR EL MAHDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR SUITE 8630
NORFOLK VA
23507
US

IV. Provider business mailing address

600 GRESHAM DR SUITE 8630
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax: 757-388-6116
Mailing address:
  • Phone: 757-388-6115
  • Fax: 757-388-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11374
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4301075357
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36458
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101237850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: