Basic Information
Provider Information
NPI: 1326301383
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATOULI
FirstName: ALI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5220 GREENS DAIRY RD
Address2:  
City: RALEIGH
State: NC
PostalCode: 276164612
CountryCode: US
TelephoneNumber: 9192563576
FaxNumber:  
Practice Location
Address1: 2111 EXCHANGE ST
Address2:  
City: ASTORIA
State: OR
PostalCode: 971033329
CountryCode: US
TelephoneNumber: 5033387525
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/24/2012
LastUpdateDate: 07/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X2021-01404NCY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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