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 1:416 DAYLIN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5603
Mailing Address - Country:US
Mailing Address - Phone:319-400-7911
Mailing Address - Fax:
Practice Address - Street 1:5601 ARRINGDON PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5678
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-09-17
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
NCRTL24-1276OtherNORTH CAROLINA MEDICAL BOARD
IAT-1185OtherBOARD NUMBER