Basic Information
| Provider Information | |||||||||
| NPI: | 1982865143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELGOHARY | ||||||||
| FirstName: | DINA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5544 GREENWICH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574660089 | ||||||||
| FaxNumber: | 7574668017 | ||||||||
| Practice Location | |||||||||
| Address1: | 5544 GREENWICH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574660089 | ||||||||
| FaxNumber: | 7574668017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116018754 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 0101250989 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10092469 | 01 | VA | SENTARA HEALTH PLAN | OTHER | P01066535 | 01 | VA | RAILROAD MEDICARE | OTHER | 1982865143 | 05 | VA | MEDICAID | 10092469 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 5917524 | 05 | NC | MEDICAID | GRP 139178 | 01 | VA | BCBSVA | OTHER |