Healthcare Provider Details

I. General information

NPI: 1295705598
Provider Name (Legal Business Name): ANAS WARDEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 APPALOOSA LN
WEST SPRINGFIELD MA
01089
US

IV. Provider business mailing address

64 APPALOOSA LN
WEST SPRINGFIELD MA
01089-1738
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-2811
  • Fax:
Mailing address:
  • Phone: 413-733-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52220
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD16939
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52220
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: