MEDICARE: SIRAH I ALI MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	21178	MD

General Provider Information

NPI Number	:	1861950784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRAH I ALI MSW

Provider Business Mailing Address
First Line	:	616 BRIDGEMAN TER
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-2402
Country	:	US
Telephone Number	:	240-907-1447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 TAYLOR AVE STE 203
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-8333
Country	:	US
Telephone Number	:	240-907-1447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2019
Last Update Date	:	03/10/2019

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