Healthcare Provider Details

I. General information

NPI: 1871785329
Provider Name (Legal Business Name): ALIA MARIE MOINUDDIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29055 CLEMENS RD STE A
WESTLAKE OH
44145-1135
US

IV. Provider business mailing address

29055 CLEMENS RD
WESTLAKE OH
44145-1135
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax: 216-450-1614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.140745
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD063634L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: