Provider Demographics
NPI:1073087656
Name:HEMATI, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:HEMATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14602 DUFIEF MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2559
Mailing Address - Country:US
Mailing Address - Phone:240-839-2807
Mailing Address - Fax:
Practice Address - Street 1:14602 DUFIEF MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2559
Practice Address - Country:US
Practice Address - Phone:240-839-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH-530-048-000-0983747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant