Provider Demographics
NPI:1578011490
Name:ALI, FAREED
Entity Type:Individual
Prefix:
First Name:FAREED
Middle Name:
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 1:4 LITTLES BROOK CT
Mailing Address - Street 2:APT 97
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-6506
Mailing Address - Country:US
Mailing Address - Phone:781-267-1378
Mailing Address - Fax:
Practice Address - Street 1:4 LITTLES BROOK CT
Practice Address - Street 2:APT 97
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-6506
Practice Address - Country:US
Practice Address - Phone:781-267-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266452390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program