Provider Demographics
NPI:1881905701
Name:ALI, ABDULFATAH AMAN (MT(ASCP), MA)
Entity type:Individual
Prefix:
First Name:ABDULFATAH
Middle Name:AMAN
Last Name:ALI
Suffix:
Gender:M
Credentials:MT(ASCP), MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3588
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-3588
Mailing Address - Country:US
Mailing Address - Phone:207-344-5143
Mailing Address - Fax:866-381-5580
Practice Address - Street 1:75 BISHOP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2614
Practice Address - Country:US
Practice Address - Phone:207-510-7680
Practice Address - Fax:866-381-5580
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care