Provider Demographics
NPI:1255370243
Name:ALI, AZRA J (MD)
Entity type:Individual
Prefix:
First Name:AZRA
Middle Name:J
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 1:89 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8925
Mailing Address - Country:US
Mailing Address - Phone:978-532-4903
Mailing Address - Fax:978-532-4995
Practice Address - Street 1:89 FOSTER ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8925
Practice Address - Country:US
Practice Address - Phone:978-532-4903
Practice Address - Fax:978-532-4995
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA153455OtherTUFTS
MAJ19702OtherBCBS OF MA
MA710534OtherHARVARD PILGRIM
MA1320912Medicaid
MAG06969Medicare UPIN
MAA28973Medicare PIN