Provider Demographics
NPI:1396761672
Name:ALI, AHMAD JAFAR (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:JAFAR
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:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0298
Mailing Address - Country:US
Mailing Address - Phone:252-482-7774
Mailing Address - Fax:252-482-7345
Practice Address - Street 1:314 W QUEEN ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1733
Practice Address - Country:US
Practice Address - Phone:252-482-7774
Practice Address - Fax:252-482-7345
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910127Medicaid
NCF81429Medicare UPIN
NC8910127Medicaid