Healthcare Provider Details

I. General information

NPI: 1508217993
Provider Name (Legal Business Name): ALI MUMTAZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8556 FORT SMALLWOOD RD
PASADENA MD
21122-2634
US

IV. Provider business mailing address

4660 WILKENS AVE STE 202
BALTIMORE MD
21229-4846
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-1190
  • Fax: 410-255-1484
Mailing address:
  • Phone: 410-242-7066
  • Fax: 410-242-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberLL9771
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: