Healthcare Provider Details

I. General information

NPI: 1396988051
Provider Name (Legal Business Name): KEVIN J MANSFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 05/17/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3478
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3478
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5088
  • Fax: 518-262-5400
Mailing address:
  • Phone: 518-262-5088
  • Fax: 518-262-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberTP389
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD181915
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE11449
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2018025924
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number321788
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: