Provider Demographics
NPI:1588649560
Name:MANSOUR, MOUSSA CHAFIC (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUSSA
Middle Name:CHAFIC
Last Name:MANSOUR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-5557
Mailing Address - Fax:617-724-1241
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:ELECTROPHYSIOLOGY LAB ARRHYTHMIA SERVICE GRB 109
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5067
Practice Address - Fax:617-724-1241
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-11-16
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Provider Licenses
StateLicense IDTaxonomies
MA161196207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24554OtherBCBS MA
MA0190811Medicaid
MA161196OtherTUFTS HEALTH PLAN
H55993Medicare UPIN
MA0190811Medicaid