Provider Demographics
NPI:1295754356
Name:ANSARA, MAHA F (MD)
Entity type:Individual
Prefix:
First Name:MAHA
Middle Name:F
Last Name:ANSARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:752 STIRLING CENTER PLACE
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4889
Mailing Address - Country:US
Mailing Address - Phone:407-333-1212
Mailing Address - Fax:407-333-1213
Practice Address - Street 1:752 STIRLING CENTER PL
Practice Address - Street 2:SUITE 1008
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4889
Practice Address - Country:US
Practice Address - Phone:407-333-1212
Practice Address - Fax:407-333-1213
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0075530207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5656OtherGROUP MEDICARE ID NUMBER
FL207RE0101XOtherTAXONOMY
FL0075530OtherMEDICAL LICENSE
FL253960800Medicaid
FLK5656OtherGROUP MEDICARE ID NUMBER
FL43321XMedicare ID - Type Unspecified
FL593511028OtherTIN