Provider Demographics
NPI:1750789111
Name:ANDALIB, ALI (MD, MSC)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ANDALIB
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PILGRIM RD # BAKER4
Mailing Address - Street 2:PALMER 409
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:617-667-8800
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD # BAKER4
Practice Address - Street 2:PALMER 409
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-667-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program