Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 015589 | CT |
Y | 208600000X | Surgeon | 015589 | CT |
NPI | 1023056462 |
---|---|
Provider Name | Dr. Vazrick Mansourian |
First Address | New Haven, CT 06511-5238 |
Second Address | New Haven, CT 06511-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 10/07/2012 |