Provider Demographics
NPI:1851913321
Name:ALI, HASSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAM
Middle Name:
Last Name:ALI
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 1:2100 STANTONSBURG RD
Mailing Address - Street 2:VIDANT MEDICAL CENTER
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-744-4560
Mailing Address - Fax:252-744-2280
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:VIDANT MEDICAL CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-744-4560
Practice Address - Fax:252-744-2280
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-02-21
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-02-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program