Provider Demographics
NPI:1336271535
Name:ALI M RAJAEE MD PA
Entity Type:Organization
Organization Name:ALI M RAJAEE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAJAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-243-2883
Mailing Address - Street 1:717 ENCINO PL NE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2611
Mailing Address - Country:US
Mailing Address - Phone:505-243-2883
Mailing Address - Fax:505-243-2884
Practice Address - Street 1:717 ENCINO PL NE
Practice Address - Street 2:SUITE 26
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2611
Practice Address - Country:US
Practice Address - Phone:505-243-2883
Practice Address - Fax:505-243-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68-155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10014OtherBCBS HMO
10624OtherLOVELACE
NM22343Medicaid
24450OtherPRESBYTERIAN SALUD
2234OtherBCBS
2104410Medicare ID - Type Unspecified
10014OtherBCBS HMO