Provider Demographics
NPI:1417902727
Name:ANSARI, MONIREH J (MD)
Entity Type:Individual
Prefix:
First Name:MONIREH
Middle Name:J
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29001 CEDAR ROAD
Mailing Address - Street 2:SUITE 518
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-461-0020
Mailing Address - Fax:440-646-8211
Practice Address - Street 1:29001 CEDAR ROAD
Practice Address - Street 2:SUITE 518
Practice Address - City:LYNDHURST
Practice Address - State:ID
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-461-0020
Practice Address - Fax:440-646-8211
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A79961Medicare UPIN
OHAN0492861Medicare ID - Type Unspecified