MEDICARE: MOHAMED FAZAL ALLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	71328	MA

General Provider Information

NPI Number	:	1295782985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED FAZAL ALLY M.D.

Provider Business Mailing Address
First Line	:	432 COLUMBIA ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02141-1039
Country	:	US
Telephone Number	:	978-256-0173
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEETING HOUSE RD
Second Line	:	UNIT 5
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-2733
Country	:	US
Telephone Number	:	978-256-0173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/08/2007

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