Provider Demographics
NPI:1154407203
Name:ALI, SYED JAFFER (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:JAFFER
Last Name:ALI
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 1:12 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2819
Mailing Address - Country:US
Mailing Address - Phone:440-232-6610
Mailing Address - Fax:440-232-7509
Practice Address - Street 1:12 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2819
Practice Address - Country:US
Practice Address - Phone:440-232-6610
Practice Address - Fax:440-232-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-037955A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406019Medicaid
OH1154407203OtherNPI
OH0406019Medicaid
OHA14916Medicare UPIN