Healthcare Provider Details

I. General information

NPI: 1750068623
Provider Name (Legal Business Name): AMMAR ALI ABEDALAZIZ ALADAILEH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 N BROADWAY # 117
BALTIMORE MD
21205-1832
US

IV. Provider business mailing address

733 N BROADWAY # 117
BALTIMORE MD
21205-1832
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5268
  • Fax:
Mailing address:
  • Phone: 410-955-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33862
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: