MEDICARE: MARYAM BINT ALI

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	172V00000X	Community Health Worker	23511	PA

General Provider Information

NPI Number	:	1912839309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM BINT ALI

Provider Business Mailing Address
First Line	:	1770 WILLIAMS RD
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1701
Country	:	US
Telephone Number	:	570-567-5400
Fax Number	:	877-551-9931

Provider Business Practice Location Address
First Line	:	471 HEPBURN ST
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-6122
Country	:	US
Telephone Number	:	570-567-5400
Fax Number	:	877-551-9931

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ MARYAM BINT ALI ” Practice Location

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