Provider Demographics
NPI:1730155268
Name:NOORI, ALICE C (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:NOORI
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 1:4552 EMPIRE CT
Mailing Address - Street 2:PL PHYSICIANS, INC.
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1939
Mailing Address - Country:US
Mailing Address - Phone:540-361-4779
Mailing Address - Fax:540-604-9893
Practice Address - Street 1:4552 EMPIRE CT
Practice Address - Street 2:PL PHYSICIANS, INC.
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-361-4779
Practice Address - Fax:540-604-9893
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014032208000000X
VA0101242280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730155268Medicaid
MEG11073Medicare UPIN
MEMM6040Medicare ID - Type Unspecified
MEQX8293Medicare PIN