Individual
DR. JOHN VICTOR MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1033 CHAMPIONS WAY, SUITE 100, SUFFOLK, VA 23435-3777
(757) 461-6997
(757) 461-6906
Mailing address
816 GREENBRIER CIR, SUITE A, CHESAPEAKE, VA 23320-2642
(757) 461-6997
(757) 461-6906
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
0101054589
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006091326
—
VA
01
—
0585010001
DME
VA
01
—
660001452
RAILROAD MEDICARE
—
Enumeration date
11/09/2005
Last updated
03/01/2013
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