1881905701 NPI number — ABDULFATAH AMAN ALI MT(ASCP), MA

Table of content: ABDULFATAH AMAN ALI MT(ASCP), MA (NPI 1881905701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881905701 NPI number — ABDULFATAH AMAN ALI MT(ASCP), MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALI
Provider First Name:
ABDULFATAH
Provider Middle Name:
AMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT(ASCP), MA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1881905701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04104-3588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-344-5143
Provider Business Mailing Address Fax Number:
866-381-5580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 BISHOP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04103-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-510-7680
Provider Business Practice Location Address Fax Number:
866-381-5580
Provider Enumeration Date:
06/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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