Provider Demographics
NPI:1215145628
Name:MANSOUR, NADIA UMAR (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:UMAR
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-708-1555
Mailing Address - Fax:440-708-1515
Practice Address - Street 1:1611 S GREEN RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4123
Practice Address - Country:US
Practice Address - Phone:440-708-1555
Practice Address - Fax:440-708-1515
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012059207R00000X
OH35-093555207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine