Provider Demographics
NPI:1497311773
Name:ASHOUR, ALI TAREQ
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:TAREQ
Last Name:ASHOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SPRUCE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5204
Mailing Address - Country:US
Mailing Address - Phone:207-329-2838
Mailing Address - Fax:
Practice Address - Street 1:980 FOREST AVE STE 106
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3357
Practice Address - Country:US
Practice Address - Phone:207-329-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME31673171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator