Provider Demographics
NPI:1023302882
Name:MANSOOR, EHAB (MD)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:
Last Name:MANSOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15010
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5010
Mailing Address - Country:US
Mailing Address - Phone:865-541-8187
Mailing Address - Fax:865-541-8286
Practice Address - Street 1:1025 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-7713
Practice Address - Country:US
Practice Address - Phone:865-541-8478
Practice Address - Fax:865-769-7959
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN507152080S0012X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002399Medicaid
TNQ002399Medicaid
TN6004203Medicaid
FLGL439YMedicare PIN