Provider Demographics
NPI:1962559534
Name:ELGANAINY, TAREK SAYED
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:SAYED
Last Name:ELGANAINY
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 1:13924 COALFIELD COMMONS PL
Mailing Address - Street 2:STE 102
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-1216
Mailing Address - Country:US
Mailing Address - Phone:804-594-1998
Mailing Address - Fax:804-594-3804
Practice Address - Street 1:13924 COALFIELD COMMONS PL
Practice Address - Street 2:STE 102
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-1216
Practice Address - Country:US
Practice Address - Phone:804-594-1998
Practice Address - Fax:804-594-3804
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555793111N00000X
GA006030111N00000X
FLCH 7767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5583633OtherAETNA PROVIDER NUMBER
VA139261OtherANTHEM BS BC
VA260788OtherSOUTHERN HEALTH PROV ID
VA00W520T01Medicare PIN