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General NPI Number Information
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NPI Number | 1689663320
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Entity Type | Individual
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Provider Name | NATHER B. ANSARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2005
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 1075 GARRISONVILLE RD SUITE 115
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City | STAFFORD
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State | VA
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Zip | 22556-8600
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Country | US
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Telephone | 540-288-9888
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Fax | 540-288-0054
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Provider Business Mailing Address
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Address Line | PO BOX 3910
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City | FREDERICKSBURG
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State | VA
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Zip | 22402-3910
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Country | US
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Telephone | 540-288-9888
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Fax | 540-288-0054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101057815
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License Number State | VA
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