Provider Demographics
NPI:1447575527
Name:ALI, OSAMA (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSAMA
Other - Middle Name:
Other - Last Name:ABONA-AMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:222 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1824
Mailing Address - Country:US
Mailing Address - Phone:859-239-5570
Mailing Address - Fax:
Practice Address - Street 1:204 BEVINS LN STE A
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6145
Practice Address - Country:US
Practice Address - Phone:502-603-9881
Practice Address - Fax:888-234-8154
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1210752084P0800X, 2084P0802X
KY470192084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100303280Medicaid
KY7100303280Medicaid