Provider Demographics
NPI:1154926608
Name:ALI, ALICIA (PA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ALI
Suffix:
Gender:
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:833 CHESTNUT ST STE 640
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4417
Mailing Address - Country:US
Mailing Address - Phone:215-955-7625
Mailing Address - Fax:215-521-7058
Practice Address - Street 1:833 CHESTNUT ST STE 640
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4417
Practice Address - Country:US
Practice Address - Phone:215-955-7625
Practice Address - Fax:215-521-7058
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA062108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant