Provider Demographics
NPI:1558005157
Name:ABBASI, AMMAAR MOHAMMAD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:AMMAAR
Middle Name:MOHAMMAD ALI
Last Name:ABBASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:4TH FLOOR, MALONEY BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2016
Mailing Address - Fax:215-662-7983
Practice Address - Street 1:3600 SPRUCE STREET
Practice Address - Street 2:4TH FLOOR, MALONEY BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-760-2693
Practice Address - Fax:215-662-7983
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2023-01-24
Deactivation Date:2023-01-18
Deactivation Code:
Reactivation Date:2023-01-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT225656390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program