Provider Demographics
NPI:1962489773
Name:ALI, IMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAN
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5814
Mailing Address - Country:US
Mailing Address - Phone:508-679-0054
Mailing Address - Fax:508-679-0354
Practice Address - Street 1:373 NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5814
Practice Address - Country:US
Practice Address - Phone:508-679-0054
Practice Address - Fax:508-679-0354
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223179207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2107759Medicaid
MAAL-A39094Medicare ID - Type Unspecified
MA2107759Medicaid