Provider Demographics
NPI:1679525786
Name:MOSHIRI, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:MOSHIRI
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 1:7 SWALLOW FARMS RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3071
Mailing Address - Country:US
Mailing Address - Phone:413-427-3576
Mailing Address - Fax:413-585-1355
Practice Address - Street 1:7 SWALLOW FARMS RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-3071
Practice Address - Country:US
Practice Address - Phone:413-427-3576
Practice Address - Fax:413-585-1355
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA586032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3075621Medicaid
MA3075621Medicaid