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General NPI Number Information
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NPI Number | 1144216649
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Entity Type | Individual
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Provider Name | ALI A AL-MUDAMGHA MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 4939 BRITTONFIELD PKWY STE 202
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9208
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Country | US
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Telephone | 315-634-6699
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Fax | 315-744-1921
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Provider Business Mailing Address
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Address Line | 301 PROSPECT AVE # MSO
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City | SYRACUSE
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State | NY
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Zip | 13203-1807
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Country | US
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Telephone | 315-448-5881
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Fax | 315-448-3548
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 187031
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 187031
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License Number State | NY
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