Provider Demographics
NPI:1952308827
Name:EL-MOHANDES, ALI ABDEL-TAWAB AMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:ABDEL-TAWAB AMIN
Last Name:EL-MOHANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:EL-MOHANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-665-9696
Mailing Address - Fax:240-420-5715
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:STE P
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4100
Practice Address - Country:US
Practice Address - Phone:301-665-9696
Practice Address - Fax:240-420-5715
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059328208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00098364OtherRAILROAD MEDICARE
MD61864001OtherBLUE CROSS
MD658LE988Medicare ID - Type UnspecifiedMEDICARE
MDF220-0006OtherBLUE CROSS REGIONAL
MD165P385GMedicare PIN
MDG02677D05Medicare PIN
MDH31112Medicare UPIN
MD401318200Medicaid