Healthcare Provider Details

I. General information

NPI: 1285921858
Provider Name (Legal Business Name): ALI REZA IMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

IV. Provider business mailing address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 740-891-9000
  • Fax: 740-891-9001
Mailing address:
  • Phone: 740-891-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35125527
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: