Provider Demographics
NPI:1699744714
Name:MOHAMED-ALI, ABUL KASSIM (MD)
Entity type:Individual
Prefix:DR
First Name:ABUL
Middle Name:KASSIM
Last Name:MOHAMED-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 1:115 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9007
Mailing Address - Country:US
Mailing Address - Phone:610-562-6099
Mailing Address - Fax:610-562-6001
Practice Address - Street 1:OLD ROUTE 22
Practice Address - Street 2:HAMBURG CENTER
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-0400
Practice Address - Country:US
Practice Address - Phone:610-562-6099
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038456L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0715202Medicaid
PA147779Medicare ID - Type Unspecified
PA0715202Medicaid