Provider Demographics
NPI:1952931917
Name:AITABDELLAH, ALI (AA)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:AITABDELLAH
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 BARBOUR RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1926
Mailing Address - Country:US
Mailing Address - Phone:804-709-6277
Mailing Address - Fax:
Practice Address - Street 1:8320 BARBOUR RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-1926
Practice Address - Country:US
Practice Address - Phone:804-709-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA63648641343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)