Provider Demographics
NPI:1962881896
Name:ANSARI, DANIYAL AHMED (MD)
Entity type:Individual
Prefix:MR
First Name:DANIYAL
Middle Name:AHMED
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN STREET
Mailing Address - Street 2:SAINT MARY'S HOSPITAL
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706
Mailing Address - Country:US
Mailing Address - Phone:203-709-6223
Mailing Address - Fax:203-709-7753
Practice Address - Street 1:56 FRANKLIN STREET
Practice Address - Street 2:SAINT MARY'S HOSPITAL
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706
Practice Address - Country:US
Practice Address - Phone:203-709-6223
Practice Address - Fax:203-709-7753
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-08-21
Deactivation Date:2016-01-15
Deactivation Code:
Reactivation Date:2016-03-30
Provider Licenses
StateLicense IDTaxonomies
FLME134856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine