Basic Information
| Provider Information | |||||||||
| NPI: | 1902172752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANSOURI | ||||||||
| FirstName: | NAHAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 FRANCIS STREET | ||||||||
| Address2: | BWH- PCCM | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177327420 | ||||||||
| FaxNumber: | 6177327421 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 E 70TH ST | ||||||||
| Address2: | 4D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473236838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 05/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.