Provider Demographics
NPI:1134246929
Name:ALI S AHMADINEJAD MD
Entity type:Organization
Organization Name:ALI S AHMADINEJAD MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:SEYED
Authorized Official - Last Name:AHMADINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-534-6210
Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:SIUTE 207
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6210
Mailing Address - Fax:610-534-6209
Practice Address - Street 1:1501 LANSDOWNE AVE
Practice Address - Street 2:SIUTE 207
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6210
Practice Address - Fax:610-534-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038453L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34272Medicare UPIN
PA044074Medicare PIN