Healthcare Provider Details

I. General information

NPI: 1245408426
Provider Name (Legal Business Name): ABDULNASSER AHMED YOUSUF ALHAJERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BEVINS LN ROM.123
GEORGETOWN KY
40324-6178
US

IV. Provider business mailing address

100 E CAMPUS VIEW BLVD STE 160
COLUMBUS OH
43235-8634
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2401
  • Fax:
Mailing address:
  • Phone: 614-340-7740
  • Fax: 614-340-7742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number2010020722
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number43585
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number43585
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43585
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number43585
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number35.136826
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number43585
License Number StateKY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7100139340
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: