Healthcare Provider Details

I. General information

NPI: 1144654187
Provider Name (Legal Business Name): WAHEEDA F. ALI, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 BEECH TREE DR
GLEN MILLS PA
19342-1172
US

IV. Provider business mailing address

PO BOX 455
GLEN MILLS PA
19342-0455
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-5088
  • Fax:
Mailing address:
  • Phone: 610-237-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD059715L
License Number StatePA

VIII. Authorized Official

Name: DR. WAHEEDA F ALI
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 610-237-5088