Healthcare Provider Details

I. General information

NPI: 1912253121
Provider Name (Legal Business Name): SANA MANSOOR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 11/27/2023
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 407
BALTIMORE MD
21215-5231
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8663
  • Fax: 410-601-5389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD008545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: