Basic Information
| Provider Information | |||||||||
| NPI: | 1831741024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | BILAL | ||||||||
| MiddleName: | ANJUM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024922505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814533777 | ||||||||
| FaxNumber: | 3303633877 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024922505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814533777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2019 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | T291900 | MA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.