Provider Demographics
NPI:1114119427
Name:ALI, BILAL (MD)
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:
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 1:1420 BEVERLY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3736
Mailing Address - Country:US
Mailing Address - Phone:703-852-8060
Mailing Address - Fax:877-743-0170
Practice Address - Street 1:1420 BEVERLY RD STE 205
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3736
Practice Address - Country:US
Practice Address - Phone:703-852-8060
Practice Address - Fax:877-743-0170
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0099335207RG0100X
DCMD210012339207RG0100X
VA0101279874207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32930356Medicare PIN