MEDICARE: NANCY ELAWABDEH MD

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	208000000X	Pediatrics Physician	S2577	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972965564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ELAWABDEH MD

Provider Business Mailing Address
First Line	:	23127 IH 10 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2507
Country	:	US
Telephone Number	:	210-922-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	23127 IH 10 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-2507
Country	:	US
Telephone Number	:	210-922-1850
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	09/30/2022

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