Provider Demographics
NPI:1861245839
Name:ELFWWAL, MENNATULLAH (MD)
Entity type:Individual
Prefix:
First Name:MENNATULLAH
Middle Name:
Last Name:ELFWWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CONN TER STE 550
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 CONN TER STE 550
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-323-5867
Practice Address - Fax:859-323-8510
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFL087207W00000X
WAMD000000207W00000X, 207WX0110X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics