Individual
DR. MOUSSA CHAFIC MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, ELECTROPHYSIOLOGY LAB ARRHYTHMIA SERVICE GRB 109, BOSTON, MA 02114-2621
(617) 726-5067
(617) 724-1241
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-5557
(617) 724-1241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
161196
MA
207RC0000X
Cardiovascular Disease Physician
161196
MA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
161196
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0190811
—
MA
01
—
161196
TUFTS HEALTH PLAN
MA
01
—
J24554
BCBS MA
MA
Enumeration date
12/13/2005
Last updated
11/16/2012
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