Intisar Ali
Individual provider Active NPI Contractor · Henrico, VA
NPI 1962289454 · NPPES record last updated Sep 11, 2023
Key facts
- NPI
- 1962289454
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 002-00769270 (VA)
- Practice address
- 404 Broad Hill TRL
Henrico, VA 23233-7853 - Phone
- (804) 269-6666
- NPI assigned
- Sep 11, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002-00769270 | VA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 002-00769270 | VA | Yes |
Addresses
Primary practice location
404 Broad Hill TRL
Henrico, VA 23233-7853
Mailing address
404 Broad Hill TRL
Henrico, VA 23233-7853
Phone (804) 269-6666
Other providers in Henrico, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.