Provider Demographics
NPI:1023428919
Name:ALI, MOHAMMAD KHIZAR (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:KHIZAR
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 1:100 BRADFORD ROAD
Mailing Address - Street 2:STE 410
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8489
Mailing Address - Country:US
Mailing Address - Phone:724-965-8946
Mailing Address - Fax:724-965-8953
Practice Address - Street 1:100 BRADFORD ROAD
Practice Address - Street 2:STE 410
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8489
Practice Address - Country:US
Practice Address - Phone:724-965-8946
Practice Address - Fax:724-965-8953
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4639342084N0400X, 2084N0600X, 208VP0014X, 2084P2900X
OH35.1367612084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine