Healthcare Provider Details

I. General information

NPI: 1720122104
Provider Name (Legal Business Name): RAHILA ANSARI MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE NEUROLOGICAL INSTITUTE - DEPT OF NEUROMUSCULAR DISEASES
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

10701 EAST BOULEVARD, 127(W) DEPT OF NEUROLOGY - CLEVELAND VA MEDICAL CENTER
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7776
  • Fax: 216-844-7624
Mailing address:
  • Phone: 216-791-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number56625
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number3560
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: