Healthcare Provider Details

I. General information

NPI: 1174056063
Provider Name (Legal Business Name): AMIR MEHDI ANSARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY DEPT OF MEDICINE
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

1101 E MARSHALL ST STE 1030
RICHMOND VA
23298-5008
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2284
  • Fax: 410-554-2184
Mailing address:
  • Phone: 410-554-2284
  • Fax: 410-554-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101269420
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD470567
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: