Provider Demographics
NPI:1730413592
Name:ALI M CARINE, DO, LLC
Entity type:Organization
Organization Name:ALI M CARINE, DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-276-2400
Mailing Address - Street 1:3300 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221
Mailing Address - Country:US
Mailing Address - Phone:614-276-2400
Mailing Address - Fax:614-276-2500
Practice Address - Street 1:3300 RIVERSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-1738
Practice Address - Country:US
Practice Address - Phone:614-276-2400
Practice Address - Fax:614-276-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2298375Medicaid