Provider Demographics
NPI:1851312755
Name:NAMI, ALIREZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:NAMI
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 1:332 LILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3130
Mailing Address - Country:US
Mailing Address - Phone:704-377-1216
Mailing Address - Fax:704-377-4661
Practice Address - Street 1:332 LILLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3130
Practice Address - Country:US
Practice Address - Phone:704-377-1216
Practice Address - Fax:704-377-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400560207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138CFMedicaid
H24281Medicare UPIN
NC2347473Medicare ID - Type Unspecified