Healthcare Provider Details

I. General information

NPI: 1205599818
Provider Name (Legal Business Name): ALI MEKBEL ALDAHMASHI JR. MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date: 03/29/2023
Reactivation Date: 02/18/2026

III. Provider practice location address

22 S. GREENE STREET ROOM N3E09
BALTIMORE MD
21201
US

IV. Provider business mailing address

22 S. GREENE STREET, BALTIMORE MD. 21201 ROOM N3E09
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6110
  • Fax:
Mailing address:
  • Phone: 410-328-0152
  • Fax: 410-328-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: