Healthcare Provider Details

I. General information

NPI: 1962881896
Provider Name (Legal Business Name): DANIYAL AHMED ANSARI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date: 01/15/2016
Reactivation Date: 03/30/2016

III. Provider practice location address

56 FRANKLIN STREET SAINT MARY'S HOSPITAL
WATERBURY CT
06706
US

IV. Provider business mailing address

56 FRANKLIN STREET SAINT MARY'S HOSPITAL
WATERBURY CT
06706
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-6223
  • Fax: 203-709-7753
Mailing address:
  • Phone: 203-709-6223
  • Fax: 203-709-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD48946
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME134856
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD48946
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: