MEDICARE: DR. AAISYA NABEEHAH ANSARI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	D0062574	MD
2	207P00000X	Emergency Medicine Physician	C0747	KY
3	207P00000X	Emergency Medicine Physician	ME132118	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D58I1	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326048752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AAISYA NABEEHAH ANSARI MD

Provider Business Mailing Address
First Line	:	12709 HALYARD PL
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-7041
Country	:	US
Telephone Number	:	404-915-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 W SAGAMORE AVE
Second Line	:
City	:	CLEWISTON
State	:	FL
Zip	:	33440-3514
Country	:	US
Telephone Number	:	863-983-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/12/2022

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