Provider Demographics
NPI:1386536688
Name:ALEMU, ELIAS W
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:W
Last Name:ALEMU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MEMORIAL DR APT 1005
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4686
Mailing Address - Country:US
Mailing Address - Phone:617-415-3364
Mailing Address - Fax:
Practice Address - Street 1:808 MEMORIAL DR APT 1005
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4686
Practice Address - Country:US
Practice Address - Phone:617-415-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-19
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS08987548343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)