Healthcare Provider Details

I. General information

NPI: 1598835860
Provider Name (Legal Business Name): ALY MOSTAFA SABET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE 209 11701 LIVINGSTON RD
FT WASHINGTON MD
20744-5136
US

IV. Provider business mailing address

STE # 209 11701 LIVINGSTON RD S# 209
FT WASHINGTON MD
20744-5136
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-3113
  • Fax: 301-292-0159
Mailing address:
  • Phone: 301-292-3113
  • Fax: 301-292-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0021833
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD11219
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: