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General NPI Number Information
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NPI Number | 1184158487
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Entity Type | Individual
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Provider Name | SARA IMTIAZ ALI
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Gender | Female
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1717 WEST MAIN ST STE 203
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City | NEWARK
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State | OH
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Zip | 43055-1501
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Country | US
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Telephone | 220-564-2950
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Fax | 220-564-2951
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Provider Business Mailing Address
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Address Line | 5832 GENESEE DR
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City | DURHAM
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State | NC
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Zip | 27712-1222
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Country | US
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Telephone | 281-975-8186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2024-03450
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 35.148566
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License Number State | OH
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