MEDICARE: NATHER B. ANSARI M.D.

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	207R00000X	Internal Medicine Physician	0101057815	VA

General Provider Information

NPI Number	:	1689663320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHER B. ANSARI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3910
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22402-3910
Country	:	US
Telephone Number	:	540-288-9888
Fax Number	:	540-288-0054

Provider Business Practice Location Address
First Line	:	1075 GARRISONVILLE RD
Second Line	:	SUITE 115
City	:	STAFFORD
State	:	VA
Zip	:	22556-8600
Country	:	US
Telephone Number	:	540-288-9888
Fax Number	:	540-288-0054

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

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	06/08/2017

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