1750362331 NPI number — ALI R NIAKOSARI M.D.

Table of content: ALI R NIAKOSARI M.D. (NPI 1750362331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750362331 NPI number — ALI R NIAKOSARI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIAKOSARI
Provider First Name:
ALI
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750362331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847235
Provider Second Line Business Mailing Address:
L&M RADIOLOGY, INC.
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-7235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-266-2676
Provider Business Mailing Address Fax Number:
978-266-2680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GENERAL ST
Provider Second Line Business Practice Location Address:
L&M RADIOLOGY, INC.
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01841-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-946-8103
Provider Business Practice Location Address Fax Number:
978-946-8067
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  229677 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2122481 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J40429 . This is a "BLUE CROSSBLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 101845900 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30206162 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96483101 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 95779 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P0036087 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 074962230 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA69178 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 101581 . This is a "HEALTHY START" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1421862 . This is a "AETNA/USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 495236 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y010905MA01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 23166 . This is a "BMC HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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