Provider Demographics
NPI:1457448995
Name:ALI, M KARIM (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:KARIM
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 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-481-1145
Mailing Address - Fax:703-481-1149
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 420
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-481-1145
Practice Address - Fax:703-481-1149
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044267207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006503322Medicaid
VA006503322Medicaid
00B766M71Medicare PIN