Healthcare Provider Details

I. General information

NPI: 1144397258
Provider Name (Legal Business Name): TAMER MANSOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIRCLE SUITE 300
STERLING VA
20166-8580
US

IV. Provider business mailing address

224D CORNWALL ST NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-430-4400
  • Fax: 703-430-4130
Mailing address:
  • Phone: 703-737-6010
  • Fax: 571-291-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number251272
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number0101237596
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101237596
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: