Healthcare Provider Details

I. General information

NPI: 1316044456
Provider Name (Legal Business Name): PYAR ALI NOORANI MD,DCH,DTM&H,MCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

IV. Provider business mailing address

408 TILLOTSON PL
DAYTON OH
45458-7318
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-8002
  • Fax: 937-641-5412
Mailing address:
  • Phone: 937-428-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD39223
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberMD39223
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35059746
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: