Provider Demographics
NPI:1992231914
Name:ALI, RUBAB
Entity type:Individual
Prefix:
First Name:RUBAB
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N EUTAW ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-6305
Mailing Address - Country:US
Mailing Address - Phone:410-225-8760
Mailing Address - Fax:410-472-5537
Practice Address - Street 1:821 N EUTAW ST STE 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-6305
Practice Address - Country:US
Practice Address - Phone:410-225-8760
Practice Address - Fax:410-472-5537
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine