Provider Demographics
NPI:1659372035
Name:AL-HUMADI, ADIL H (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIL
Middle Name:H
Last Name:AL-HUMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ADIL
Other - Middle Name:H
Other - Last Name:AL-HUMADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2223 W STATE ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-372-9629
Mailing Address - Fax:716-372-9638
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:SUITE 117
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-372-9629
Practice Address - Fax:716-372-9638
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120097-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
283015003OtherTRAVELERS MDB
NY1401542OtherIHA
NY000506398001OtherBLUE CROSS
001304052OtherPA BLUE SHIELD
00010001801OtherUNIVERA
NY00604480Medicaid
NY1401542OtherIHA
NY063981Medicare ID - Type Unspecified