Individual
ISHRAT MANSURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6058
(617) 730-4841
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
004124
NY
208000000X
Pediatrics Physician
106825
MN
208000000X
Pediatrics Physician
56984
MN
2080P0206X
Pediatric Gastroenterology Physician
Primary
267632
MA
2080P0206X
Pediatric Gastroenterology Physician
56984
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
11/13/2009
Last updated
12/07/2021
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