Provider Demographics
NPI:1689000879
Name:SALIM Y. MANSOOR M.D., P.A.
Entity Type:Organization
Organization Name:SALIM Y. MANSOOR M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-8155
Mailing Address - Street 1:7501 SURRATTS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3350
Mailing Address - Country:US
Mailing Address - Phone:301-856-8155
Mailing Address - Fax:240-244-5222
Practice Address - Street 1:7501 SURRATTS RD STE 110
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3350
Practice Address - Country:US
Practice Address - Phone:301-856-8155
Practice Address - Fax:240-244-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty