Provider Demographics
NPI:1982790713
Name:ALI, FAHAD MN (MD)
Entity Type:Individual
Prefix:DR
First Name:FAHAD
Middle Name:MN
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:505 PLANTATION ST APT 421
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4337
Mailing Address - Country:US
Mailing Address - Phone:508-414-6039
Mailing Address - Fax:508-791-1878
Practice Address - Street 1:55 LAKE AVENUE NORTH
Practice Address - Street 2:UMASS MEMORIAL MEDICAL CENTER
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:508-421-1401
Practice Address - Fax:508-421-1490
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158939207P00000X, 207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology