Provider Demographics
NPI:1508093394
Name:ANSARI, OSAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
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:PO BOX 677879
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32867-7879
Mailing Address - Country:US
Mailing Address - Phone:407-440-3004
Mailing Address - Fax:407-429-3899
Practice Address - Street 1:4882 QUALITY TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8203
Practice Address - Country:US
Practice Address - Phone:407-440-3004
Practice Address - Fax:407-429-3899
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114061207R00000X
TXBP10033998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine