Provider Demographics
NPI:1497160808
Name:ALY, RAGIA M (MD)
Entity type:Individual
Prefix:
First Name:RAGIA
Middle Name:M
Last Name:ALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-7676
Mailing Address - Fax:
Practice Address - Street 1:1130 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-434-7676
Practice Address - Fax:321-952-6179
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME166307207RX0202X, 207RH0000X, 207RH0000X
CT1.063925208M00000X
IN11022659A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9472OtherMEDICARE HF
FL122897300Medicaid