Healthcare Provider Details

I. General information

NPI: 1801727904
Provider Name (Legal Business Name): ELA NEUROLOGY & ADVANCED HEADACHE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8219 LEESBURG PIKE STE 201
VIENNA VA
22182-2625
US

IV. Provider business mailing address

8219 LEESBURG PIKE STE 201
VIENNA VA
22182-2625
US

V. Phone/Fax

Practice location:
  • Phone: 410-440-0654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELAHE BORDBAR
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 410-440-0654