Basic Information
| Provider Information | |||||||||
| NPI: | 1811235930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELGASIM | ||||||||
| FirstName: | MAGDI | ||||||||
| MiddleName: | ABUSNENA | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2617 CROFTON SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276154059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195223727 | ||||||||
| FaxNumber: | 9196818076 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2013 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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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 | 1744R1102X | Y | Other Service Providers | Specialist | Research Study |
ID Information
| ID | Type | State | Issuer | Description | 1744R1102X | 01 | RESEARCH STUDY | OTHER |