Provider Demographics
NPI:1932554938
Name:MANSOORI, PARISA (MD)
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:MANSOORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1730
Mailing Address - Country:US
Mailing Address - Phone:317-250-9900
Mailing Address - Fax:
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2919
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0081
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082705A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics