Provider Demographics
NPI:1336526284
Name:MANSOUR-ATTAALLA, MADONNA IBRAHIM (DO)
Entity Type:Individual
Prefix:DR
First Name:MADONNA
Middle Name:IBRAHIM
Last Name:MANSOUR-ATTAALLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MADONNA
Other - Middle Name:
Other - Last Name:MANSOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:586 E 187TH ST
Mailing Address - Street 2:2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:917-960-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304026-01207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine