Healthcare Provider Details

I. General information

NPI: 1861420663
Provider Name (Legal Business Name): MONA E MANSOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 11032
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 11032
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-8259
  • Fax: 513-636-6419
Mailing address:
  • Phone: 513-636-8259
  • Fax: 513-636-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOH35067371
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: