Provider Demographics
NPI:1063683217
Name:ALI, RIYAZ MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:RIYAZ
Middle Name:MOHAMMED
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824339
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4339
Mailing Address - Country:US
Mailing Address - Phone:866-709-4485
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:301-475-6204
Practice Address - Fax:301-997-6507
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442908207L00000X
VA0101249934207L00000X
MDD0072618207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD235199Medicare PIN