Provider Demographics
NPI:1336288539
Name:ALI, MIR MUMTAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:MUMTAZ
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 1:706 WILKINS ST STE A
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4662
Mailing Address - Country:US
Mailing Address - Phone:919-989-1800
Mailing Address - Fax:919-989-1802
Practice Address - Street 1:706 WILKINS ST STE A
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4662
Practice Address - Country:US
Practice Address - Phone:919-989-1800
Practice Address - Fax:919-989-1802
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136U4Medicaid
NC2026237Medicare PIN
NCD14436Medicare UPIN
NC89136U4Medicaid