Provider Demographics
NPI:1871804393
Name:ALSUBAI, JELAL (MD)
Entity type:Individual
Prefix:DR
First Name:JELAL
Middle Name:
Last Name:ALSUBAI
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 1:2501 PARKERS LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3209
Mailing Address - Country:US
Mailing Address - Phone:703-664-7000
Mailing Address - Fax:703-664-7666
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-664-7000
Practice Address - Fax:703-664-7666
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449268207R00000X
VA0101258152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30161128OtherAMERIHEALTH CARITAS PA - WMG
PA102840389Medicaid
PA30161126OtherAMERIHEALTH CARITAS PA - THFP
PA420280OtherUPMC
PA2899305OtherHIGHMARK BLUE SHIELD
PA2899305OtherHIGHMARK BLUE SHIELD
PA30161128OtherAMERIHEALTH CARITAS PA - WMG
PAP01272023Medicare PIN
PA302801FLTMedicare PIN