Provider Demographics
NPI:1205988011
Name:ABDALLAH, MAHER ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MAHER
Middle Name:ALI
Last Name:ABDALLAH
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 1:1199 N INDIAN CANYON DR STE A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4836
Mailing Address - Country:US
Mailing Address - Phone:760-346-4334
Mailing Address - Fax:760-346-3663
Practice Address - Street 1:1199 N INDIAN CANYON DR
Practice Address - Street 2:STE. A
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4836
Practice Address - Country:US
Practice Address - Phone:760-346-4334
Practice Address - Fax:760-346-3663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG99679Medicare UPIN