Individual
ELIE MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
47 COLLEGE ST FL 2, NEW HAVEN, CT 06510-3209
(203) 785-5461
Mailing address
47 COLLEGE ST FL 2, NEW HAVEN, CT 06510-3209
(203) 785-5461
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
R79404
AZ
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
77352
CT
390200000X
Student in an Organized Health Care Education/Training Program
0116035966
VA
Other
Enumeration date
07/07/2021
Last updated
07/25/2024
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