Provider Demographics
NPI:1467421917
Name:MANSFIELD, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:MANSFIELD
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 1:406 9TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7276
Mailing Address - Country:US
Mailing Address - Phone:619-338-0911
Mailing Address - Fax:619-338-0933
Practice Address - Street 1:406 9TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7276
Practice Address - Country:US
Practice Address - Phone:619-338-0911
Practice Address - Fax:619-338-0933
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0794172085R0202X
CAG633342085R0202X, 207RM1200X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300121591OtherRAILROAD MEDICARE
OH000000196899OtherANTHEM BCBS
OH2244217Medicaid
CAAZ464YMedicare PIN
OH2244217Medicaid
OH000000196899OtherANTHEM BCBS
CAE83340Medicare UPIN