Provider Demographics
NPI:1437128196
Name:AL ADSANI, WASL (DO)
Entity Type:Individual
Prefix:
First Name:WASL
Middle Name:
Last Name:AL ADSANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:WASL
Other - Middle Name:
Other - Last Name:AL-ADSANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-2045
Practice Address - Fax:252-744-3525
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-50163207Q00000X
IA3620207Q00000X
AZ005199390200000X
NC2021-02234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0472555Medicaid
COCOAAA1285Medicare UPIN