Provider Demographics
NPI:1538799523
Name:ELSADIG, ELBASHIR ELNAZIR MOHAMED
Entity type:Individual
Prefix:
First Name:ELBASHIR
Middle Name:ELNAZIR MOHAMED
Last Name:ELSADIG
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 1:500 ROOSEVELT BLVD APT 506
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-3109
Mailing Address - Country:US
Mailing Address - Phone:571-351-7707
Mailing Address - Fax:
Practice Address - Street 1:500 ROOSEVELT BLVD APT 506
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-3109
Practice Address - Country:US
Practice Address - Phone:571-351-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)