Individual
MOHAMMAD TARIQ ANSARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE B480, GREENVILLE, SC 29615-3593
(864) 454-4200
(864) 454-4205
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8611
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
15259
SC
207RP1001X
Pulmonary Disease Physician
Primary
15259
SC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
15259
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152596
—
SC
01
—
290010760
RR MEDICARE
SC
Enumeration date
05/06/2006
Last updated
07/19/2021
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