Provider Demographics
NPI:1326484783
Name:ALI, MOHAMMAD RAZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:RAZA
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0617
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:2545 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7300
Practice Address - Country:US
Practice Address - Phone:484-884-9677
Practice Address - Fax:484-884-9297
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458554207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031707870002Medicaid
PA547850PZPOtherMEDICARE PTAN