Provider Demographics
NPI:1083466098
Name:ALI, MOHAMED ABDELNASSER IBRAHIM (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:ABDELNASSER IBRAHIM
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2386
Mailing Address - Fax:617-789-2438
Practice Address - Street 1:235 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1794
Practice Address - Country:US
Practice Address - Phone:508-427-3190
Practice Address - Fax:508-427-3210
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-10-02
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MA3016172207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program