Provider Demographics
NPI:1932174786
Name:JARRAHI, ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:JARRAHI
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 1:2830 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4100
Mailing Address - Country:US
Mailing Address - Phone:336-768-2424
Mailing Address - Fax:
Practice Address - Street 1:2830 MAPLEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4100
Practice Address - Country:US
Practice Address - Phone:336-768-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC167222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018082OtherVALUE OPTIONS
NC45827OtherBLUE CROSS BLUE SHIELD
NC10247OtherMBC
NC8945827Medicaid
NC10247OtherMBC
NC45827OtherBLUE CROSS BLUE SHIELD
NC201504Medicare ID - Type Unspecified