Provider Demographics
NPI:1023709375
Name:ANSARI, MOHAMMED AHMED HUSSAIN
Entity type:Individual
Prefix:
First Name:MOHAMMED AHMED
Middle Name:HUSSAIN
Last Name:ANSARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1418
Mailing Address - Country:US
Mailing Address - Phone:410-719-7608
Mailing Address - Fax:410-719-0400
Practice Address - Street 1:5624 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1418
Practice Address - Country:US
Practice Address - Phone:410-719-7608
Practice Address - Fax:410-719-0400
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT28051183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician