Healthcare Provider Details

I. General information

NPI: 1356962609
Provider Name (Legal Business Name): SHAHAB ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2276
  • Fax: 215-214-4119
Mailing address:
  • Phone: 215-707-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD483393
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: