Provider Demographics
NPI:1881830883
Name:ANSARI, ERUM (MD)
Entity Type:Individual
Prefix:
First Name:ERUM
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 1:1081 MARKET PL STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4750
Mailing Address - Country:US
Mailing Address - Phone:925-275-0404
Mailing Address - Fax:925-275-0488
Practice Address - Street 1:1081 MARKET PL STE 800
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4750
Practice Address - Country:US
Practice Address - Phone:925-275-0404
Practice Address - Fax:925-275-0488
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-21
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 1020692080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine