# DR. MOUSSA CHAFIC MANSOUR

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1588649560
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 161196 | MA | — |
| 207RC0000X | Cardiovascular Disease Physician | 161196 | MA | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | 161196 | MA | Yes |

## Other

- **Enumeration date:** 12/13/2005
- **Last updated:** 11/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0190811 | — | MA |
| 01 | — | 161196 | TUFTS HEALTH PLAN | MA |
| 01 | — | J24554 | BCBS MA | MA |