Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS041511 | PA |
N | 1223X0400X | Orthodontists | DS041511 | PA |
NPI | 1154095263 |
---|---|
Provider Name | Dr. Mohammad Taqi Qali |
First Address | Philadelphia, PA 19107-5127 |
Second Address | Philadelphia, PA 19107-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |