Healthcare Provider Details

I. General information

NPI: 1750369310
Provider Name (Legal Business Name): ALI R TURAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WALNUT ST
FALL RIVER MA
02720-3315
US

IV. Provider business mailing address

465 WALNUT ST
FALL RIVER MA
02720-3315
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-8348
  • Fax: 774-365-6615
Mailing address:
  • Phone: 508-674-8348
  • Fax: 774-365-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81638
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3142701
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: