MEDICARE: MOHAMMAD ALI 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	282625	NY

General Provider Information

NPI Number	:	1710248471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD ALI M.D.

Provider Business Mailing Address
First Line	:	105 COUNTY ROUTE 45A STE 400
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-6673
Country	:	US
Telephone Number	:	315-312-0889
Fax Number	:	315-312-0110

Provider Business Practice Location Address
First Line	:	105 COUNTY ROUTE 45A STE 400
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-6673
Country	:	US
Telephone Number	:	315-312-0889
Fax Number	:	315-312-0110

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	09/14/2023

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Directions to “ MOHAMMAD ALI M.D.” Practice Location

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