Provider Demographics
NPI:1528186285
Name:ELBOGDADI, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ELBOGDADI
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 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-3132
Practice Address - Street 1:14995 SHADY GROVE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-217-9241
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077404207RR0500X
VA0101241193207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA102538OtherMEDICARE PTAN
VA1417027608OtherROCKINGHAM MEMORIAL GROUP NPI
VAC05754OtherROCKINGHAM MEMORIAL MEDICARE GROUP PTAN