Provider Demographics
NPI:1861469611
Name:ALLEY, ALI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:A
Last Name:ALLEY
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 1:301 WEST THIRD STREET
Mailing Address - Street 2:ALI A ALLEY MD PC
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-759-0351
Mailing Address - Fax:570-759-1992
Practice Address - Street 1:301 WEST THIRD STREET
Practice Address - Street 2:ALI A ALLEY MD PC
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-759-0351
Practice Address - Fax:570-759-1992
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025475L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000614840Medicaid
013580Medicare ID - Type Unspecified
B96178Medicare UPIN