Provider Demographics
NPI:1861411647
Name:ZAIDI, MANSOOR ANWER (MD)
Entity type:Individual
Prefix:
First Name:MANSOOR
Middle Name:ANWER
Last Name:ZAIDI
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 1:575 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2223
Mailing Address - Country:US
Mailing Address - Phone:413-534-2570
Mailing Address - Fax:413-534-2613
Practice Address - Street 1:447 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2320
Practice Address - Country:US
Practice Address - Phone:203-678-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232468207R00000X
MA236499207R00000X
CT50367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02585899Medicaid
NY2117653OtherCIGNA
NY1245941OtherAETNA - HMO
NY2117653OtherEMPIRE BC/BS
NY7699782OtherAETNA - PPO
NY02585899Medicaid
G98617Medicare UPIN