Healthcare Provider Details

I. General information

NPI: 1184794463
Provider Name (Legal Business Name): M I ALI MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N JEFFERSON ST
NEW CASTLE PA
16101-2271
US

IV. Provider business mailing address

217 NORTH JEFFERSON STREET
NEW CASTLE PA
16101-2271
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-9721
  • Fax: 724-658-3542
Mailing address:
  • Phone: 724-658-9721
  • Fax: 724-658-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD035335L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MOHAMMAD IRSHAD ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 724-658-9721