Healthcare Provider Details

I. General information

NPI: 1073282158
Provider Name (Legal Business Name): AHMAD SAEED DERBALA ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR STE 1420
NEWARK DE
19713-2049
US

IV. Provider business mailing address

200 HYGEIA DR STE 1420
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-3017
  • Fax: 302-266-9962
Mailing address:
  • Phone: 302-623-3017
  • Fax: 302-266-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD490488
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0106114
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1-0028687
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: