Provider Demographics
NPI:1477507713
Name:ANSARI, AMIR Z (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:Z
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2910 EAST FRANKLIN BLVD #1
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7225
Mailing Address - Country:US
Mailing Address - Phone:704-648-0460
Mailing Address - Fax:855-446-7146
Practice Address - Street 1:1190 FILBERT HWY STE 110
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-9324
Practice Address - Country:US
Practice Address - Phone:803-628-0004
Practice Address - Fax:803-628-6004
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00448207Q00000X
SC23848207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNNK077H224OtherMEDICARE
SCSC8646L064OtherMEDICARE