Provider Demographics
NPI:1255643482
Name:ANSARI, SAQUIB (MD)
Entity type:Individual
Prefix:DR
First Name:SAQUIB
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 1:285 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WELLAND
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L3B 5E6
Mailing Address - Country:CA
Mailing Address - Phone:905-735-7667
Mailing Address - Fax:905-735-2997
Practice Address - Street 1:285 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:WELLAND
Practice Address - State:ONTARIO
Practice Address - Zip Code:L3B 5E6
Practice Address - Country:CA
Practice Address - Phone:905-735-7667
Practice Address - Fax:905-735-2997
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255096207Q00000X
ZZON-CANADA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine