Provider Demographics
NPI:1558336040
Name:MANSOUR, MAGUID NOSSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGUID
Middle Name:NOSSHI
Last Name:MANSOUR
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 1:5000 RUSHLIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1298
Mailing Address - Country:US
Mailing Address - Phone:301-596-0077
Mailing Address - Fax:301-596-0077
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:201
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:301-927-1550
Practice Address - Fax:301-596-0077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00162022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD173-752Medicare ID - Type Unspecified
MDE63701Medicare UPIN