Provider Demographics
NPI:1912197013
Name:ANSARI, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2443
Mailing Address - Country:US
Mailing Address - Phone:617-789-2904
Mailing Address - Fax:
Practice Address - Street 1:ST. ELIZABETH'S MEDICAL CENTER/ DEPT OF HEERE/ONC
Practice Address - Street 2:736 CAMBRIDGE STREET
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:01235
Practice Address - Country:US
Practice Address - Phone:617-789-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229525207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology