Provider Demographics
NPI:1194382887
Name:ALI, CH HASSAN (MD)
Entity type:Individual
Prefix:
First Name:CH HASSAN
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 1:34 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5687
Mailing Address - Country:US
Mailing Address - Phone:301-326-8421
Mailing Address - Fax:
Practice Address - Street 1:905 UNION ST STE 9
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3039
Practice Address - Country:US
Practice Address - Phone:301-326-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2023-05-11
Deactivation Date:2020-01-16
Deactivation Code:
Reactivation Date:2020-02-26
Provider Licenses
StateLicense IDTaxonomies
DC390200000X
MEMD268612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program