Provider Demographics
NPI:1215211032
Name:ESMADI, MOHAMMAD ALI (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ALI
Last Name:ESMADI
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 1:1900 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6616
Mailing Address - Country:US
Mailing Address - Phone:919-235-6440
Mailing Address - Fax:
Practice Address - Street 1:1900 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6616
Practice Address - Country:US
Practice Address - Phone:919-235-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28244208M00000X
IA41733208M00000X, 208M00000X
NC2016-01651207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470687317-16Medicaid
NE100263273-00Medicaid
IA1215211032Medicaid
NE100263273-00Medicaid
IA058970043Medicare PIN