Provider Demographics
NPI:1396988051
Name:MANSFIELD, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:MANSFIELD
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 1:43 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3478
Mailing Address - Country:US
Mailing Address - Phone:518-262-5088
Mailing Address - Fax:518-262-5400
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3478
Practice Address - Country:US
Practice Address - Phone:518-262-5088
Practice Address - Fax:518-262-5400
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP389207T00000X
ORMD181915207T00000X
ARE11449207T00000X
MO2018025924207T00000X
390200000X
NY321788207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD181915OtherOREGON STATE MEDICAL BOARD