Provider Demographics
NPI:1417679192
Name:BARBACHAN MANSUR, NACIME SALOMAO (MD, PHD)
Entity type:Individual
Prefix:
First Name:NACIME SALOMAO
Middle Name:
Last Name:BARBACHAN MANSUR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CLEARFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4707
Mailing Address - Country:US
Mailing Address - Phone:319-400-7911
Mailing Address - Fax:
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-554-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT-1185207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0104527OtherMARYLAND BOARD OF PHYSICIANS
NCRTL24-1276OtherNORTH CAROLINA MEDICAL BOARD
IAT-1185OtherBOARD NUMBER