Provider Demographics
NPI:1316294622
Name:MANSOURI, BEHZAD
Entity type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:MANSOURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MONSIGNOR OBRIEN HWY
Mailing Address - Street 2:409
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1289
Mailing Address - Country:US
Mailing Address - Phone:857-253-8474
Mailing Address - Fax:
Practice Address - Street 1:243 CHARLES ST.
Practice Address - Street 2:MEEI
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3412
Practice Address - Fax:617-573-3851
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist