Healthcare Provider Details

I. General information

NPI: 1134474976
Provider Name (Legal Business Name): ALIAKBAR RASHID DADLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 320
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

24 PARK PL APT 18 D
HARTFORD CT
06106-5008
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2550
  • Fax: 360-514-1927
Mailing address:
  • Phone: 914-312-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD61148959
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61148959
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-11133
License Number StateAR
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61148959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: