Provider Demographics
NPI:1083233373
Name:ALI, MADIHA AMJAD (MD)
Entity type:Individual
Prefix:MISS
First Name:MADIHA
Middle Name:AMJAD
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 RESERVOIR AVE STE 6A
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4450
Mailing Address - Country:US
Mailing Address - Phone:401-942-2320
Mailing Address - Fax:
Practice Address - Street 1:725 RESERVOIR AVE STE 6A
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4450
Practice Address - Country:US
Practice Address - Phone:401-942-2320
Practice Address - Fax:401-942-2375
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD19150207Q00000X
OH57.249476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine