Provider Demographics
NPI:1295994465
Name:ANSARI, SAMREEN ARIF (MD)
Entity type:Individual
Prefix:
First Name:SAMREEN
Middle Name:ARIF
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 1:3930 PENDER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0985
Mailing Address - Country:US
Mailing Address - Phone:703-620-6221
Mailing Address - Fax:703-620-6628
Practice Address - Street 1:3930 PENDER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0985
Practice Address - Country:US
Practice Address - Phone:703-620-6221
Practice Address - Fax:703-620-6628
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253418207RG0300X
VA0101249672207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC238636ZCDVOtherMEDICARE PTAN
VA1295994465Medicaid
DC238636ZCDVOtherMEDICARE PTAN