Active NPI
Stefan Mansourian, MD
- Diagnostic Radiology Physician
- West Haven, CT
National Provider Identifier
1063694081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 54766
- Practice address
- 950 Campbell Ave
Department of Radiology
West Haven, CT 06516-2770 - Phone
- (203) 932-5711
- NPI assigned
- Nov 30, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 54766 | CT | Primary |
Addresses
Primary practice location
950 Campbell Ave
Department of Radiology
West Haven, CT 06516-2770
Mailing address
950 Campbell Ave
Department of Radiology
West Haven, CT 06516-2770
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 |
|---|---|---|---|
| 54766 | CT | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447804800000",
"number": "1063694081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 CAMPBELL AVE",
"address_2": "DEPARTMENT OF RADIOLOGY",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065162770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 CAMPBELL AVE",
"address_2": "DEPARTMENT OF RADIOLOGY",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065162770",
"telephone_number": "203-932-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOURIAN",
"first_name": "STEFAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-30",
"last_updated": "2015-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CT",
"license": "54766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.