Provider Demographics
NPI:1386620078
Name:ALI, IRFANA (MD)
Entity type:Individual
Prefix:
First Name:IRFANA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10540 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2426
Mailing Address - Country:US
Mailing Address - Phone:301-949-0030
Mailing Address - Fax:301-949-0033
Practice Address - Street 1:10540 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2426
Practice Address - Country:US
Practice Address - Phone:301-949-0030
Practice Address - Fax:301-949-0033
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33999207P00000X
MDD0055147207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034519200Medicaid
DC44330039OtherBLUECROSS BLUESHIELD
F39451Medicare UPIN
DC034519200Medicaid