Healthcare Provider Details

I. General information

NPI: 1205355351
Provider Name (Legal Business Name): SAMI ANSAR AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 NORTH BROAD STREET
LANSDALE PA
19446-1002
US

IV. Provider business mailing address

1970 NORTH BROAD STREET
LANSDALE PA
19446-1002
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-1900
  • Fax: 215-368-8772
Mailing address:
  • Phone: 215-368-1900
  • Fax: 215-368-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD492559
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: