Provider Demographics
NPI:1427005487
Name:ANSARI, YASMIN (MD)
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 NE 138TH PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4600
Mailing Address - Country:US
Mailing Address - Phone:503-367-3134
Mailing Address - Fax:
Practice Address - Street 1:552 NE 138TH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4600
Practice Address - Country:US
Practice Address - Phone:503-367-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23791207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269780Medicaid
ORP00438698OtherRR MEDICARE - PROVIDENCE
ORR161095Medicare PIN
ORT133569Medicare PIN
ORI47292Medicare UPIN
ORR161094Medicare PIN
ORR136355Medicare PIN
OR269780Medicaid