Provider Demographics
NPI:1275595944
Name:AHMED, MANSOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:
Last Name:AHMED
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 1:29099 HEALTH CAMPUS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5269
Mailing Address - Country:US
Mailing Address - Phone:440-239-7533
Mailing Address - Fax:440-239-2585
Practice Address - Street 1:29099 HEALTH CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5269
Practice Address - Country:US
Practice Address - Phone:440-239-7533
Practice Address - Fax:440-239-2585
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064077207RC0200X, 207RP1001X
OH35064077207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH339970001OtherCARESOURCE
OH000000121632OtherANTHEM
OH0911311Medicaid
OH0911311Medicaid
OH339970001OtherCARESOURCE
OHF57499Medicare UPIN