Provider Demographics
NPI:1184158487
Name:ALI, SARA IMTIAZ
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:IMTIAZ
Last Name:ALI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5832 GENESEE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1222
Mailing Address - Country:US
Mailing Address - Phone:281-975-8186
Mailing Address - Fax:
Practice Address - Street 1:1717 WEST MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1501
Practice Address - Country:US
Practice Address - Phone:220-564-2950
Practice Address - Fax:220-564-2951
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-03450207RG0100X
OH35.148566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology