Provider Demographics
NPI:1497833826
Name:ANSARI, NASRIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NASRIN
Middle Name:
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 1:200 BANNING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-674-0600
Mailing Address - Fax:302-672-7144
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:STE 200
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-674-0600
Practice Address - Fax:302-672-7144
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00408568OtherRAILROAD MEDICARE
DE1497833826Medicaid
DEI40568Medicare UPIN
DE1497833826Medicaid