Provider Demographics
NPI:1699787341
Name:ALI, MOHAMMAD IRSHAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:IRSHAD
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 1:217 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2271
Mailing Address - Country:US
Mailing Address - Phone:724-658-9721
Mailing Address - Fax:724-658-3542
Practice Address - Street 1:217 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2271
Practice Address - Country:US
Practice Address - Phone:724-658-9721
Practice Address - Fax:724-658-3542
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035335L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005866840004Medicaid
PA115409LQBMedicare PIN
PA0005866840004Medicaid
PAC30561Medicare UPIN