Provider Demographics
NPI:1346433059
Name:ATHAR M. ANSARI M D INC.
Entity Type:Organization
Organization Name:ATHAR M. ANSARI M D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHAR
Authorized Official - Middle Name:MASOOD
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-484-3937
Mailing Address - Street 1:PO BOX 2575
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91903-2575
Mailing Address - Country:US
Mailing Address - Phone:760-353-3222
Mailing Address - Fax:760-353-3311
Practice Address - Street 1:790 W ORANGE AVE
Practice Address - Street 2:STE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3274
Practice Address - Country:US
Practice Address - Phone:760-353-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50706207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50706OtherMEDICARE PROVIDER NUMBER
CAG25776Medicare UPIN