Healthcare Provider Details

I. General information

NPI: 1942408943
Provider Name (Legal Business Name): KAMRAN MANZOOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVE
WOONSOCKET RI
02895-4705
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4100
  • Fax:
Mailing address:
  • Phone: 401-729-2635
  • Fax: 401-729-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number14403
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD14403
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: