Provider Demographics
NPI:1780662312
Name:MANSOURI, ARASH (MD)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:MANSOURI
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 1:110 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1924
Mailing Address - Country:US
Mailing Address - Phone:540-371-2020
Mailing Address - Fax:540-373-0141
Practice Address - Street 1:110 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1924
Practice Address - Country:US
Practice Address - Phone:540-371-2020
Practice Address - Fax:540-373-0141
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180037939OtherMEDICARE RAILROAD
VA6308384Medicaid
G98321Medicare UPIN
VA180000829Medicare PIN