MEDICARE: DR. MANSUR ISMAIL NATHOO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G1969	TX
2	2084P0800X	Psychiatry Physician	G1969	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00SJ65	OTHER	TX	MEDICARE
5	060002186	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	10016466	OTHER	TX	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881670404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANSUR ISMAIL NATHOO M.D.

Provider Business Mailing Address
First Line	:	15414 PINENUT BAY CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3297
Country	:	US
Telephone Number	:	281-338-2290
Fax Number	:	281-338-6728

Provider Business Practice Location Address
First Line	:	1300 BAY AREA BLVD
Second Line	:	B150-12
City	:	HOUSTON
State	:	TX
Zip	:	77058-2505
Country	:	US
Telephone Number	:	281-338-2290
Fax Number	:	281-338-6728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	09/07/2016

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Directions to “ DR. MANSUR ISMAIL NATHOO M.D.” Practice Location

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