Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD470949 | PA |
NPI | 1003172867 |
---|---|
Provider Name | Tarik Z Ali |
First Address | Hershey, PA 17033 |
Second Address | Hershey, PA 17033-0858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 17/07/2020 |