Healthcare Provider Details

I. General information

NPI: 1083607840
Provider Name (Legal Business Name): ALI YOUSUFUDDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/07/2023
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ST PAUL DR STE B
CHAMBERSBURG PA
17201-1020
US

IV. Provider business mailing address

69 ST PAUL DR STE B
CHAMBERSBURG PA
17201-1020
US

V. Phone/Fax

Practice location:
  • Phone: 717-218-8800
  • Fax: 717-552-2196
Mailing address:
  • Phone: 717-218-8800
  • Fax: 717-552-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD422419
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD422419
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: