Provider Demographics
NPI:1386616134
Name:MANSOUR, MAHER MONIR (MD)
Entity type:Individual
Prefix:
First Name:MAHER
Middle Name:MONIR
Last Name:MANSOUR
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 1:2644 MIDDLETON RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1512
Mailing Address - Country:US
Mailing Address - Phone:330-342-1140
Mailing Address - Fax:330-836-6742
Practice Address - Street 1:3200 W MARKET ST
Practice Address - Street 2:STE 205
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3335
Practice Address - Country:US
Practice Address - Phone:330-836-6825
Practice Address - Fax:330-836-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061917M2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0967468Medicaid
OH0729187Medicare ID - Type Unspecified
OH0967468Medicaid