Provider Demographics
NPI:1720069214
Name:AFROOKTEH, ALI JAMES (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:JAMES
Last Name:AFROOKTEH
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 1:300 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4541
Mailing Address - Country:US
Mailing Address - Phone:301-662-8119
Mailing Address - Fax:301-696-0985
Practice Address - Street 1:300 W 9TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4541
Practice Address - Country:US
Practice Address - Phone:301-662-8119
Practice Address - Fax:301-696-0985
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00355183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110047912OtherMEDICARE RAILROAD
MD172006924OtherMEDICAID NPI
MD477571600Medicaid
MD110047912OtherMEDICARE RAILROAD
MDD75155Medicare UPIN