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General NPI Number Information
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NPI Number | 1497311773
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Entity Type | Individual
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Provider Name | ALI TAREQ ASHOUR
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | PO BOX 878
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City | PORTLAND
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State | ME
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Zip | 04104-0878
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Country | US
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Telephone | 207-939-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 12 SPRUCE ST STE 5
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City | AUGUSTA
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State | ME
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Zip | 04330-5204
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Country | US
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Telephone | 207-329-2838
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 31673
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License Number State | ME
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