Provider Demographics
NPI:1790923951
Name:MONIM MANSOUR, NASSIR HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:NASSIR
Middle Name:HASSAN
Last Name:MONIM MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NASSIR
Other - Middle Name:
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6001 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1502
Mailing Address - Country:US
Mailing Address - Phone:614-546-4621
Mailing Address - Fax:614-546-4536
Practice Address - Street 1:6001 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1502
Practice Address - Country:US
Practice Address - Phone:614-546-4621
Practice Address - Fax:614-546-4536
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285013-1207T00000X
IL036134334207T00000X
PAMD450309207T00000X
MI4301104161207T00000X
OH35.144360207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-134334OtherSTATE LICENSE
OH35.144360OtherLICENSE
NY285013OtherLICENSE