Basic Information
| Provider Information | |||||||||
| NPI: | 1972506855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | SABA | ||||||||
| MiddleName: | AZHER | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635221 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138917574 | ||||||||
| FaxNumber: | 5137931032 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 ARROW SPRINGS BLVD STE 2700 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450367019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132827911 | ||||||||
| FaxNumber: | 5132827900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/16/2006 | ||||||||
| NPIReactivationDate: | 03/27/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35081444 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RG0300X | 35081444 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2565399 | 05 | OH | MEDICAID | 64111867 | 05 | KY | MEDICAID | 2608280 | 05 | OH | MEDICAID | P00284132 | 01 | OH | RAILROAD MEDICARE | OTHER |