Individual provider Active NPI

Kanwal Mansur, MS, CNS, LDN, MBBS

  • Nutritionist
  • Prince Frederick, MD
National Provider Identifier
1982273215
Registry record updated Apr 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
NutritionistTaxonomy code 133N00000X
License
DX5303 Issued in MD
Practice address
110 Hospital Rd Ste 101
Prince Frederick, MD 20678-4019
Phone
(410) 535-8195
Fax
(410) 280-7323
NPI assigned
Jun 21, 2021
Last updated
Apr 8, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nutritionist 133N00000X DX5303 MD Primary

Addresses

Primary practice location

110 Hospital Rd Ste 101
Prince Frederick, MD 20678-4019

Mailing address

110 Hospital Rd Ste 101
Prince Frederick, MD 20678-4019
Phone (410) 535-8195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210909002103 MD Practitioner - Registered Dietitian Or Nutrition Professional 7416353859 Reassigns benefits to 2 organizations
I20230824000038 DC Practitioner - Registered Dietitian Or Nutrition Professional 7416353859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Calverthealth Medical Group, LLCGroup PAC ID 2163562695, 50 clinicians

Practice addresses (Care Compare)

Waldorf, MD 20601
Phone (240) 460-8290

1036 Saint Nicholas Dr
Unit 101
Waldorf, MD 20603-4758
Phone (410) 414-2788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science

State licenses

LicenseStateTypeSpecialty
DX5303MDMDNutritionist

Practice roles

OrganizationSpecialtyStatusNew patients
Kssential Nutrition LLC Nutritionist CurrentSince Jun 17, 2021 Accepting new patients
Medstar Medical Group - Southern Maryland LLC Current Accepting new patients
Medstar Medical Group - Southern Maryland LLC CurrentSince Jul 2, 2023 Accepting new patients

Locations

24035 Three Notch Rd
Hollywood, MD 20636
Phone (301) 373-2588

10 Saint Patricks Dr
Waldorf, MD 20603
Phone (301) 705-7870

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1982273215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HOSPITAL RD STE 101",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784019",
            "telephone_number": "410-535-8195",
            "fax_number": "410-280-7323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HOSPITAL RD STE 101",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206784019",
            "telephone_number": "410-535-8195",
            "fax_number": "410-280-7323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSUR",
        "first_name": "KANWAL",
        "name_prefix": "Dr.",
        "credential": "MS, CNS, LDN, MBBS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "MD",
            "license": "DX5303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.