Active NPI
Khubaib Mansori, M.D.
- Clinic/Center
- Cheshire, CT
National Provider Identifier
1053764308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 025900
- Practice address
- 430 Highland Ave
Cheshire, CT 06410-2565 - Phone
- (919) 518-2115
- NPI assigned
- Jul 21, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 025900 | CT | Primary |
Addresses
Primary practice location
430 Highland Ave
Cheshire, CT 06410-2565
Mailing address
430 Highland Ave
Cheshire, CT 06410-2565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025900 | CT | MD | Clinic/Center |
Interoperability endpoints
- https://api.platform.athenahealth.com/16153/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469059200000",
"number": "1053764308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 HIGHLAND AVE",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064102565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 HIGHLAND AVE",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064102565",
"telephone_number": "919-518-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSORI",
"first_name": "KHUBAIB",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-21",
"last_updated": "2016-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "CT",
"license": "025900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheshire, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.