Provider Demographics
NPI:1518046994
Name:MAHMOOD, MANSOOR
Entity Type:Individual
Prefix:
First Name:MANSOOR
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANSOOR
Other - Middle Name:
Other - Last Name:MAHMOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41527-0144
Mailing Address - Country:US
Mailing Address - Phone:606-456-3477
Mailing Address - Fax:606-456-8246
Practice Address - Street 1:48 PHILLIPS BRANCH RD
Practice Address - Street 2:BOX 1085
Practice Address - City:PHELPS
Practice Address - State:KY
Practice Address - Zip Code:41553-9061
Practice Address - Country:US
Practice Address - Phone:606-456-3477
Practice Address - Fax:606-456-8246
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1938201Medicare ID - Type Unspecified