Basic Information
Provider Information | |||||||||
NPI: | 1689663247 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALI | ||||||||
FirstName: | ARAS | ||||||||
MiddleName: | O. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5520 | ||||||||
Address2: |   | ||||||||
City: | BETHLEHEM | ||||||||
State: | PA | ||||||||
PostalCode: | 180150520 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109545810 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 801 OSTRUM ST | ||||||||
Address2: |   | ||||||||
City: | BETHLEHEM | ||||||||
State: | PA | ||||||||
PostalCode: | 180151000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109545810 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/17/2005 | ||||||||
LastUpdateDate: | 06/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD419204 | PA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 30008993 | 01 | PA | KEYSTONE MERCY | OTHER | 20023932 | 01 | PA | AMERIHEALTH MERCY | OTHER | 000000144144 | 01 | PA | THREE RIVERS | OTHER | 8886709 | 05 | NJ |   | MEDICAID | 2075397000 | 01 | PA | INDEP. BLUE CROSS | OTHER | 1384637 | 01 | PA | KHP CENTRAL | OTHER | 1384637 | 01 | PA | HIGHMARK | OTHER | 0019103050004 | 05 | PA |   | MEDICAID | 01530442 | 01 | PA | GATEWAY | OTHER |