Healthcare Provider Details

I. General information

NPI: 1689960155
Provider Name (Legal Business Name): GABRIEL MANSOURATY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N ELAM AVE
GREENSBORO NC
27403-1127
US

IV. Provider business mailing address

DUKE UNIVERSITY HOSPITAL BOX 3913
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1745
  • Fax:
Mailing address:
  • Phone: 919-681-8852
  • Fax: 919-684-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL-248537
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014-00064
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2014-00064
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: