Provider Demographics
NPI:1306842083
Name:ALI, JUAN OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:OMAR
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 CENTRAL AVE 209
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2432
Mailing Address - Country:US
Mailing Address - Phone:215-725-7600
Mailing Address - Fax:215-725-7700
Practice Address - Street 1:7500 CENTRAL AVE 209
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2432
Practice Address - Country:US
Practice Address - Phone:215-725-7600
Practice Address - Fax:215-725-7700
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423731207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1146316Medicaid
PA1146316Medicaid
PA084530Medicare ID - Type Unspecified