MEDICARE: ELBASHIR ELNAZIR MOHAMED ELSADIG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1538799523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELBASHIR ELNAZIR MOHAMED ELSADIG

Provider Business Mailing Address
First Line	:	500 ROOSEVELT BLVD APT 506
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-3109
Country	:	US
Telephone Number	:	571-351-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 ROOSEVELT BLVD APT 506
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-3109
Country	:	US
Telephone Number	:	571-351-7707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2020
Last Update Date	:	01/19/2020

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