Provider Demographics
NPI:1801001615
Name:ALI, MAHMUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMUD
Middle Name:
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 1:1208 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-2017
Mailing Address - Country:US
Mailing Address - Phone:610-437-6490
Mailing Address - Fax:610-437-5812
Practice Address - Street 1:325 PINE ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4554
Practice Address - Country:US
Practice Address - Phone:484-546-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52793-020207Q00000X
PAMD441717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine