Provider Demographics
NPI:1639118565
Name:EROL, ALI O (MD)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:O
Last Name:EROL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 WETHERSFIELD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114
Mailing Address - Country:US
Mailing Address - Phone:860-296-6006
Mailing Address - Fax:860-296-6007
Practice Address - Street 1:901 WETHERSFIELD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114
Practice Address - Country:US
Practice Address - Phone:860-296-6006
Practice Address - Fax:860-296-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT036014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001360148Medicaid
CT001360148Medicaid
CT110007977Medicare ID - Type Unspecified