Provider Demographics
NPI:1316981780
Name:ELNESR, MOMEN M (MD)
Entity type:Individual
Prefix:DR
First Name:MOMEN
Middle Name:M
Last Name:ELNESR
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 1:64 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2610
Mailing Address - Country:US
Mailing Address - Phone:207-760-9090
Mailing Address - Fax:207-492-4889
Practice Address - Street 1:64 BARTON ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2610
Practice Address - Country:US
Practice Address - Phone:207-760-9090
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1582662084P0800X, 2084P0802X
ME139572084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME9150281047OtherMEDICAL EDUCATION NUMBER
ME13957OtherLICENSE
MA158266OtherPHYSICIAN LICENSE
ME9150281047OtherMEDICAL EDUCATION NUMBER