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General NPI Number Information
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NPI Number | 1346567310
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE DIGESTIVE HEALTH PLLC
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 1212 SPRUCE ST SUITE 207
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City | BELMONT
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State | NC
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Zip | 28012-3385
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Country | US
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Telephone | 704-461-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 SPRUCE ST SUITE 207
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City | BELMONT
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State | NC
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Zip | 28012-3385
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Country | US
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Telephone | 704-461-0161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KHALED FOUAD ELRAIE
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Credential | MD
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Telephone | 704-461-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200101332
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License Number State | NC
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