Basic Information
| Provider Information | |||||||||
| NPI: | 1699232041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELHEFNAWI | ||||||||
| FirstName: | EHAB | ||||||||
| MiddleName: | KHAMIS | ||||||||
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| Credential: | MEDICAL DOCTOR | ||||||||
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| OtherLastName: | ELHIFNAWY | ||||||||
| OtherFirstName: | EHAB | ||||||||
| OtherMiddleName: | KHAMIS ELSAID AHMED | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER | ||||||||
| Address2: | 43 WHITING HILL ROAD, STE. 300 | ||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079735035 | ||||||||
| FaxNumber: | 2079735042 | ||||||||
| Practice Location | |||||||||
| Address1: | EMMC ANESTHESIA PROFESSIONAL SERVICE | ||||||||
| Address2: | 489 STATE STREET | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072750987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2019 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD16212 | ME | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.