1972506855 NPI number — SABA AZHER ANSARI MD

Table of content: SABA AZHER ANSARI MD (NPI 1972506855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972506855 NPI number — SABA AZHER ANSARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANSARI
Provider First Name:
SABA
Provider Middle Name:
AZHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972506855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-7574
Provider Business Mailing Address Fax Number:
513-793-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ARROW SPRINGS BLVD STE 2700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45036-7019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-282-7911
Provider Business Practice Location Address Fax Number:
513-282-7900
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  35081444 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X , with the licence number: 35081444 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2608280 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64111867 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2565399 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00284132 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".