Mohamed Abdelnasser Ibrahim Ali, MD
Individual provider Active NPI Internal Medicine Physician · Brockton, MA
NPI 1083466098 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1083466098
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 3016172 (MA)
- Practice address
- 235 N Pearl St
Brockton, MA 02301-1794 - Phone
- (508) 427-3190
- Fax
- (508) 427-3210
- NPI assigned
- Apr 3, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260421000476 | MA | Order and Referring Only - Internal Medicine |
6901372564 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3016172 | MA | MD | Internal Medicine Physician |
Interoperability endpoints
- mali257538@direct.bmc.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 3016172 | MA | Yes |
Addresses
Primary practice location
235 N Pearl St
Brockton, MA 02301-1794
Mailing address
736 Cambridge St
Boston, MA 02135-2907
Phone (617) 789-2386
Other practice location 1
2100 Dorchester Avenue
Steward Carney Hospital Residency Program, 7th Floor-ro
Boston, MA 02124
Phone (617) 506-2726
Other practice location 2
736 Cambridge St
Boston, MA 02135-2907
Phone (617) 789-2386
Other providers in Brockton, MA
- Nashaley Alfama
- Gloria Alfaro-Nieves
- Catia Sofia Algarvio
- Jessica Hope Alger
- Emily Ali
- Align Behavioral Health LLC
- Rima Ali Aljundi
- Diala Alkhalil
- Ezdean Alkurdi
- All Purpose LLC
All providers in Brockton, MA · Internal Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.