Provider Demographics
NPI:1932105103
Name:ABRISHAMI, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ABRISHAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMAD ALI
Other - Middle Name:
Other - Last Name:ABRISHAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8957 EDMONSTON RD
Mailing Address - Street 2:STE M
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4047
Mailing Address - Country:US
Mailing Address - Phone:301-441-2300
Mailing Address - Fax:301-345-5467
Practice Address - Street 1:8957 EDMONSTON RD
Practice Address - Street 2:STE M
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4047
Practice Address - Country:US
Practice Address - Phone:301-441-2300
Practice Address - Fax:301-345-5467
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016484207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41519-1700Medicaid
MD1024OtherBC/BS
MDT5302OtherTRIGON
DC2569OtherBC/BS
MD0200021OtherUNITED HEALTHCARE
MD05977OtherAMERIGROUP
MD24182OtherMDIPA
MD4080880OtherAETNA
MD24182OtherMDIPA
MD41519-1700Medicaid