Provider Demographics
NPI:1083607840
Name:YOUSUFUDDIN, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:YOUSUFUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ST PAUL DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1020
Mailing Address - Country:US
Mailing Address - Phone:717-218-8800
Mailing Address - Fax:717-552-2196
Practice Address - Street 1:69 ST PAUL DR STE B
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1020
Practice Address - Country:US
Practice Address - Phone:717-218-8800
Practice Address - Fax:717-552-2196
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422419207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1569284OtherGATEWAY
PA2154658OtherMAMSI
PA50083161OtherCAPITAL BLUECROSS (PMFC)
PA922049-04OtherCAREFIRST MD (PMFC)
PA1511160OtherHIGHMARK BLUESHIELD
PA25-1716306OtherINTERGROUP
PA25-1716306OtherDEVON
PAP00458429OtherRAILROAD MEDICARE
PA050514OtherMEDICARE GROUP #
PA1763477OtherAETNA HMO (AFC)
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherINFORMED
PA25-1716306OtherMULTIPLAN/PHCS
PA100816820 0003Medicaid
PA25-1716306OtherFIRST HEALTH
PAPEARL PROVIDEROtherHEALTH AMERICA
PA227939OtherUNISON (AFC)
PA50073146OtherCAPITAL BLUECROSS (AFC)
PA7741677OtherAETNA NON-HMO
PA1007307260037OtherMEDICAID GROUP # (PMFC)
PA100816820 0001Medicaid
PA289723OtherUNISON (PMFC)
PAMD422419OtherLICENSE
PA100816820 0002Medicaid
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAV132-0001OtherCAREFIRST DC (PMFC)
PA1007307260036OtherMEDICAID GROUP # (AFC)
PA120420418OtherDEPT OF LABOR
PA6802723OtherAETNA HMO (PMFC)
PA6802723OtherAETNA HMO (PMFC)
PA7741677OtherAETNA NON-HMO
PAH93920Medicare UPIN