Provider Demographics
NPI:1801899158
Name:ALI, ABBAS SYED (MD)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:SYED
Last Name:ALI
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-1200
Mailing Address - Country:US
Mailing Address - Phone:304-598-4800
Mailing Address - Fax:
Practice Address - Street 1:3190 CITRUS TOWER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-242-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83898207RC0000X
PAMD068643L207RC0000X
WV27177207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115321OtherAMERIGROUP MCD PROV ID #
G52162Medicare UPIN
FL06512OtherBCBS OF FL PROV ID #
FL0075540002OtherCIGNA PROV ID #
FL2096502OtherUNITED H'CARE PROV ID #
FL218589OtherSTAYWELL MCD PROV ID #
FL218598OtherHEALTHEASE MCD PROV ID #
FL218598OtherWELLCARE PROV ID #
FL7910177OtherAETNA PROV ID
FL060069693OtherRAILROAD MEDICARE
FL16389OtherFHHS PROV ID #
FL06512VMedicare PIN
FL1076653OtherHUMANA PROV ID #
FL265538100Medicaid
FL1360760OtherFIRST HEALTH PROV ID #
FL182580OtherGREAT WEST PROV ID #