Basic Information
| Provider Information | |||||||||
| NPI: | 1013179654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELNAGAR | ||||||||
| FirstName: | KHALID | ||||||||
| MiddleName: | ABDELSALAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751069 | ||||||||
| Address2: | ECU PHYSICIANS | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 905 JOHNS HOPKINS DR | ||||||||
| Address2: | ECU PHYSICIANS PSYCHIATRIC OUTPATIENT CENTER | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278342056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527441406 | ||||||||
| FaxNumber: | 2527444243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 262343 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 2015-01748 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1013179654 | 05 | NC | MEDICAID | 19D6E | 01 | NC | BCBS NC | OTHER | AA-11156482598 | 01 | NY | ID NUMBER AT ALBANY MEDICAL CENTER | OTHER |