Provider Demographics
NPI:1104183029
Name:BEG, MANSOOR
Entity Type:Individual
Prefix:
First Name:MANSOOR
Middle Name:
Last Name:BEG
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 1:9327 VANGUARD CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-8292
Mailing Address - Country:US
Mailing Address - Phone:410-804-1688
Mailing Address - Fax:410-529-8513
Practice Address - Street 1:4339 EBENEZER RD
Practice Address - Street 2:OWINGS MILLS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2143
Practice Address - Country:US
Practice Address - Phone:410-804-1688
Practice Address - Fax:410-529-8513
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist