Healthcare Provider Details

I. General information

NPI: 1194249565
Provider Name (Legal Business Name): MOHAMMED ALI JALOUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACKSTONE STREET 2ND FLOOR
PROVIDENCE RI
02903
US

IV. Provider business mailing address

455 TOLL GATE ROAD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7520
  • Fax: 401-453-7529
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD20859
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: