Healthcare Provider Details

I. General information

NPI: 1538146915
Provider Name (Legal Business Name): CLEMENT ELECHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

IV. Provider business mailing address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-3530
  • Fax: 540-776-2036
Mailing address:
  • Phone: 540-772-3530
  • Fax: 540-776-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101231018
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: