MEDICARE: AMIR MANSOORY MD

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	208600000X	Surgery Physician	C1OD00529	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972589950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR MANSOORY MD

Provider Business Mailing Address
First Line	:	324 E MAIN ST
Second Line	:	SUITE 204
City	:	NEWARK
State	:	DE
Zip	:	19711-7150
Country	:	US
Telephone Number	:	302-737-4990
Fax Number	:	302-737-5082

Provider Business Practice Location Address
First Line	:	324 E MAIN ST
Second Line	:	SUITE 204
City	:	NEWARK
State	:	DE
Zip	:	19711-7150
Country	:	US
Telephone Number	:	302-737-4990
Fax Number	:	302-737-5082

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	06/13/2012

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Directions to “ AMIR MANSOORY MD” Practice Location

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