Basic Information
| Provider Information | |||||||||
| NPI: | 1477507713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | AMIR | ||||||||
| MiddleName: | Z | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 EAST FRANKLIN BLVD #1 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280567225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046480460 | ||||||||
| FaxNumber: | 8554467146 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 EAST FRANKLIN BLVD #1 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280567225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046480460 | ||||||||
| FaxNumber: | 8554467146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 23848 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 2006-00448 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | NNK077H224 | 01 | NC | MEDICARE | OTHER | SC8646L064 | 01 | SC | MEDICARE | OTHER |