Provider Demographics
NPI:1770584260
Name:MANSOORY, MAJID (MD)
Entity type:Individual
Prefix:
First Name:MAJID
Middle Name:
Last Name:MANSOORY
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 1:1701 AUGUSTINE CUT OFF
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4415
Mailing Address - Country:US
Mailing Address - Phone:302-652-3016
Mailing Address - Fax:302-571-6270
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-4415
Practice Address - Country:US
Practice Address - Phone:302-652-3016
Practice Address - Fax:302-571-6270
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC 100016452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
146243P25Medicare ID - Type Unspecified
C48748Medicare UPIN