Provider Demographics
NPI:1477255891
Name:ALI, MOHAMMED AHMED
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:AHMED
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HAMPSHIRE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4210
Mailing Address - Country:US
Mailing Address - Phone:937-818-3121
Mailing Address - Fax:
Practice Address - Street 1:615 HAMPSHIRE RD APT 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4210
Practice Address - Country:US
Practice Address - Phone:937-818-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUA862958172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver