=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326140542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALI A HAMDAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 07/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 PARRISH ST
-----------------------------------------------------
City | CANANDAIGUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14424-1731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-396-6000
-----------------------------------------------------
Fax | 585-978-8302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 WOODGREEN DR
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-9437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-498-1116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 243136-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 243136-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 243136
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 243136-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------