MEDICARE: RASHID MOIN ANSARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2019-00195	NC
2	207Q00000X	Family Medicine Physician	MD51329	SC

General Provider Information

NPI Number	:	1265851091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHID MOIN ANSARI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15033 BALLANCROFT PKWY STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4959
Country	:	US
Telephone Number	:	704-316-2920
Fax Number	:	704-316-2921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	05/15/2025

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