Healthcare Provider Details

I. General information

NPI: 1134105141
Provider Name (Legal Business Name): MICHAEL ANVARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 RIVA RD STE 114
ANNAPOLIS MD
21401-7428
US

IV. Provider business mailing address

2629 RIVA RD STE 114
ANNAPOLIS MD
21401-7428
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-2530
  • Fax: 410-573-2536
Mailing address:
  • Phone: 410-573-2530
  • Fax: 410-573-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0069793
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberD0069793
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: