Healthcare Provider Details

I. General information

NPI: 1477858827
Provider Name (Legal Business Name): NADIA ANSARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLOBAL WAY STE 119
LINTHICUM MD
21090-2222
US

IV. Provider business mailing address

605 GLOBAL WAY STE 119
LINTHICUM MD
21090-2222
US

V. Phone/Fax

Practice location:
  • Phone: 410-789-7337
  • Fax: 410-789-0425
Mailing address:
  • Phone: 667-888-7337
  • Fax: 410-789-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD74709
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: