Provider Demographics
NPI:1134465404
Name:AL-DAGHMIN, ALI AHMAD ISHAQ
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:AHMAD ISHAQ
Last Name:AL-DAGHMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:AL-DAGHMIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6 SPINDRIFT CT
Mailing Address - Street 2:APRT 4
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7839
Mailing Address - Country:US
Mailing Address - Phone:716-352-6667
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:CELL AND VIRUS BUILDING 216
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP85263208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology