Provider Demographics
NPI:1447657150
Name:ELYAS, SAMMY (MD)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:ELYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMI
Other - Middle Name:ELYAS ALAWED
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:120 N CEDAR ST APT 3816
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1293
Mailing Address - Country:US
Mailing Address - Phone:202-790-0756
Mailing Address - Fax:
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-951-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-00071208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4791598OtherAETNA
NC5881078OtherUNITED HEALTHCARE
NCFH1101980OtherFIRST CAROLINA CARE
NC13477061OtherPHCS/MULTIPLAN
NC1447657150Medicaid
NC260609OtherMEDCOST
NC5339371OtherCIGNA - GREATWEST
NC19H2JOtherBCBS OF NC