Provider Demographics
NPI:1891044814
Name:AL DAMEH, ALI OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:OMAR
Last Name:AL DAMEH
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 1:1575 TREMONT ST
Mailing Address - Street 2:FLAT 204
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1677
Mailing Address - Country:US
Mailing Address - Phone:617-480-0471
Mailing Address - Fax:
Practice Address - Street 1:1575 TREMONT ST
Practice Address - Street 2:FLAT 204
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-1677
Practice Address - Country:US
Practice Address - Phone:617-480-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251274282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital