Healthcare Provider Details
I. General information
NPI: 1750362331
Provider Name (Legal Business Name): ALI R NIAKOSARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 11/09/2005
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 GENERAL ST L&M RADIOLOGY, INC.
LAWRENCE MA
01841-2961
US
IV. Provider business mailing address
PO BOX 847235 L&M RADIOLOGY, INC.
BOSTON MA
02284-7235
US
V. Phone/Fax
- Phone: 978-946-8103
- Fax: 978-946-8067
- Phone: 978-266-2676
- Fax: 978-266-2680
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 229677 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 2122481 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
| # 2 | |
| Identifier | J40429 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BLUE CROSSBLUE SHIELD |
| # 3 | |
| Identifier | 101845900 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | CIGNA |
| # 4 | |
| Identifier | 30206162 |
| Identifier Type | MEDICAID |
| Identifier State | NH |
| Identifier Issuer | |
| # 5 | |
| Identifier | 96483101 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | NETWORK HEALTH |
| # 6 | |
| Identifier | 95779 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | FALLON |
| # 7 | |
| Identifier | P0036087 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROAD MEDICARE |
| # 8 | |
| Identifier | 074962230 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CHAMPUS/TRICARE |
| # 9 | |
| Identifier | AA69178 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | HARVARD PILGRIM |
| # 10 | |
| Identifier | 101581 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | HEALTHY START |
| # 11 | |
| Identifier | 1421862 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA/USHC |
| # 12 | |
| Identifier | 495236 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | TUFTS |
| # 13 | |
| Identifier | 01Y010905MA01 |
| Identifier Type | OTHER |
| Identifier State | NH |
| Identifier Issuer | ANTHEM |
| # 14 | |
| Identifier | 23166 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BMC HEALTHNET PLAN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
