Provider Demographics
NPI:1073596748
Name:DOWLATDAD, ALI (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:DOWLATDAD
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:P,O. BOX 23200
Mailing Address - Street 2:MEDICAL SPECIALTY SOLUTIONS
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:503-670-6322
Mailing Address - Fax:503-968-2779
Practice Address - Street 1:2055 EXCHANGE ST
Practice Address - Street 2:SUITE 270
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3419
Practice Address - Country:US
Practice Address - Phone:503-325-9597
Practice Address - Fax:503-325-9639
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14231208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106252Medicaid
OR106252Medicaid
ORR0000BKBJKMedicare PIN