MEDICARE: DR. DIMA ALI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	0101057049	VA

General Provider Information

NPI Number	:	1588783476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMA ALI M.D.

Provider Business Mailing Address
First Line	:	1801 ROBERT FULTON DR
Second Line	:	SUITE 540
City	:	RESTON
State	:	VA
Zip	:	20191-5461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 ROBERT FULTON DR
Second Line	:	SUITE 540
City	:	RESTON
State	:	VA
Zip	:	20191-5461
Country	:	US
Telephone Number	:	703-787-9866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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