Provider Demographics
NPI:1023056462
Name:MANSOURIAN, VAZRICK (MD)
Entity type:Individual
Prefix:DR
First Name:VAZRICK
Middle Name:
Last Name:MANSOURIAN
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 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-776-5819
Mailing Address - Fax:203-772-7906
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-776-5819
Practice Address - Fax:203-772-7906
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery