Provider Demographics
NPI:1487817672
Name:NOOR, FAZLE ALI (MD)
Entity Type:Individual
Prefix:
First Name:FAZLE
Middle Name:ALI
Last Name:NOOR
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 1:1501 LANSDOWNE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:610-534-6230
Mailing Address - Fax:
Practice Address - Street 1:1501 LANSDOWNE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1333
Practice Address - Country:US
Practice Address - Phone:610-534-6230
Practice Address - Fax:610-872-5188
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08558300207RN0300X
PAMD433184207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023025310002Medicaid