Provider Demographics
NPI:1194756593
Name:MANSURI, FAIZMOHAMED M (MD)
Entity type:Individual
Prefix:DR
First Name:FAIZMOHAMED
Middle Name:M
Last Name:MANSURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SOMERSET CLOSE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-2110
Mailing Address - Country:US
Mailing Address - Phone:570-589-0707
Mailing Address - Fax:570-955-1971
Practice Address - Street 1:340 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1782
Practice Address - Country:US
Practice Address - Phone:570-589-0707
Practice Address - Fax:570-955-1971
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1736698OtherBCBS
PA101437233001Medicaid
I39207Medicare UPIN
PA306319Medicare PIN
PA093918QR8Medicare ID - Type Unspecified