1134246929 NPI number — ALI S AHMADINEJAD MD

Table of content: (NPI 1134246929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134246929 NPI number — ALI S AHMADINEJAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALI S AHMADINEJAD MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALI AHMADI MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134246929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 LANSDOWNE AVE
Provider Second Line Business Mailing Address:
SIUTE 207
Provider Business Mailing Address City Name:
DARBY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19023-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-534-6210
Provider Business Mailing Address Fax Number:
610-534-6209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
SIUTE 207
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-534-6210
Provider Business Practice Location Address Fax Number:
610-534-6209
Provider Enumeration Date:
03/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHMADINEJAD
Authorized Official First Name:
ALI
Authorized Official Middle Name:
SEYED
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-534-6210

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD038453L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com