Provider Demographics
NPI:1285263186
Name:ELTATAWY, ALI RADA (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:RADA
Last Name:ELTATAWY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 CHAPLIN PL APT 609
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4170
Mailing Address - Country:US
Mailing Address - Phone:419-508-1029
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR RM 4D37
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-2364
Practice Address - Country:US
Practice Address - Phone:301-435-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD5000029622084N0400X
OH57.2495952084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology