Provider Demographics
NPI:1942292040
Name:ANSARI, SHOUKATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOUKATH
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ENDO LN
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4562
Mailing Address - Country:US
Mailing Address - Phone:843-479-6268
Mailing Address - Fax:
Practice Address - Street 1:102 ENDO LN
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4562
Practice Address - Country:US
Practice Address - Phone:910-205-3035
Practice Address - Fax:910-205-3062
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27767207RG0100X
SC10779207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100009710OtherRR MEDICARE
SC100008692OtherRR MEDICARE
SCD091992621OtherMEDICARE
SC107798Medicaid
NC11568OtherNC BC INDIVIDUAL
NC2223641OtherMEDICARE
NC8911568Medicaid
NC11568OtherNC BC INDIVIDUAL