Provider Demographics
NPI:1528247772
Name:ELMASRY, MEDHAT (MD)
Entity type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:ELMASRY
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:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7805
Mailing Address - Country:US
Mailing Address - Phone:276-728-3332
Mailing Address - Fax:276-728-3302
Practice Address - Street 1:430 W STUART DR
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1527
Practice Address - Country:US
Practice Address - Phone:276-728-3332
Practice Address - Fax:276-728-3302
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF25218Medicare UPIN