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General NPI Number Information
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NPI Number | 1134246929
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Entity Type | Organization
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Legal Business Name | ALI S AHMADINEJAD MD
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 1501 LANSDOWNE AVE SIUTE 207
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City | DARBY
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State | PA
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Zip | 19023-1333
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Country | US
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Telephone | 610-534-6210
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Fax | 610-534-6209
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Provider Business Mailing Address
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Address Line | 1501 LANSDOWNE AVE SIUTE 207
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City | DARBY
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State | PA
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Zip | 19023-1333
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Country | US
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Telephone | 610-534-6210
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Fax | 610-534-6209
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALI SEYED AHMADINEJAD
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Credential | MD
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Telephone | 610-534-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD038453L
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License Number State | PA
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