Provider Demographics
NPI:1750362331
Name:NIAKOSARI, ALI R (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:R
Last Name:NIAKOSARI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 847235
Mailing Address - Street 2:L&M RADIOLOGY, INC.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7235
Mailing Address - Country:US
Mailing Address - Phone:978-266-2676
Mailing Address - Fax:978-266-2680
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:L&M RADIOLOGY, INC.
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-946-8103
Practice Address - Fax:978-946-8067
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-04-19
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Provider Licenses
StateLicense IDTaxonomies
MA2296772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2122481Medicaid
MAJ40429OtherBLUE CROSSBLUE SHIELD
MA101845900OtherCIGNA
NH30206162Medicaid
MA96483101OtherNETWORK HEALTH
MA95779OtherFALLON
P0036087OtherRAILROAD MEDICARE
074962230OtherCHAMPUS/TRICARE
MAAA69178OtherHARVARD PILGRIM
MA101581OtherHEALTHY START
1421862OtherAETNA/USHC
MA495236OtherTUFTS
NH01Y010905MA01OtherANTHEM
MA23166OtherBMC HEALTHNET PLAN
MAAA69178OtherHARVARD PILGRIM
MAA4061901Medicare PIN