Provider Demographics
NPI:1174326136
Name:NASRALLAH, MOHAMAD ALI (MD/PHD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:ALI
Last Name:NASRALLAH
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17529 MYRON ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3116
Mailing Address - Country:US
Mailing Address - Phone:917-238-8244
Mailing Address - Fax:
Practice Address - Street 1:395 W 12TH AVE STE 346A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-9812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program