1952501736 NPI number — DR. ABDISALAN ALI AFRAH M.D

Table of content: MS. KOASTER BRIM MSW,LMSW (NPI 1083080857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952501736 NPI number — DR. ABDISALAN ALI AFRAH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AFRAH
Provider First Name:
ABDISALAN
Provider Middle Name:
ALI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1952501736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISONBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22803-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-564-5791
Provider Business Mailing Address Fax Number:
540-437-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 BEAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-232-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007

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: 207R00000X , with the licence number:  0101242022 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 54021 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1952501736 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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