Provider Demographics
NPI:1356768287
Name:MUSTAFA ALI, MOAATH KHADER (MD)
Entity type:Individual
Prefix:
First Name:MOAATH
Middle Name:KHADER
Last Name:MUSTAFA 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 1:10201 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2130
Mailing Address - Country:US
Mailing Address - Phone:216-444-2200
Mailing Address - Fax:216-444-9464
Practice Address - Street 1:10201 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2130
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:216-444-9464
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35129504207R00000X
OH35.129504207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226241Medicaid