Healthcare Provider Details

I. General information

NPI: 1457866519
Provider Name (Legal Business Name): MOHAMMAD JAMAL UDDIN ANSARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 03/07/2023
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 SAINT CHARLES WAY
YORK PA
17402-4648
US

IV. Provider business mailing address

292 SAINT CHARLES WAY
YORK PA
17402-4648
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6231
  • Fax:
Mailing address:
  • Phone: 717-851-6231
  • Fax: 717-741-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036145361
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD469208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: