Provider Demographics
NPI:1114127693
Name:ALI, NOAMAN SYED (MD)
Entity Type:Individual
Prefix:
First Name:NOAMAN
Middle Name:SYED
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SYED
Other - Middle Name:NOAMAN
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1825 KINGSLEY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4478
Mailing Address - Country:US
Mailing Address - Phone:904-264-5426
Mailing Address - Fax:904-264-5427
Practice Address - Street 1:1825 KINGSLEY AVE STE 150
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4478
Practice Address - Country:US
Practice Address - Phone:904-264-5426
Practice Address - Fax:904-264-5427
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090762208600000X
OH35-121257208600000X
FLME164623208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH0086219Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #