Provider Demographics
NPI:1225276488
Name:MANSOUR, MOHAMED MOHSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MOHSEN
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:26 RESEARCH WAY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3526
Practice Address - Country:US
Practice Address - Phone:631-444-1750
Practice Address - Fax:631-444-7502
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250693207RP1001X, 207R00000X, 207RC0200X, 390200000X
FLME126865207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program