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Individual

DR. TALLAT MAHMOOD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-8200
(315) 464-8289
Mailing address
251 SALINA MEADOWS PKWY STE 100, SYRACUSE, NY 13212-4516
(315) 464-2014

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
308286
NY
207RH0003X
Hematology & Oncology Physician
4301077088
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0M76680004
MEDICARE ADVANTAGE
MI
01
1017788
MCLAREN HEALTH PLAN-MEDICAID
MI
01
1103312201
BCBS/BCN
MI
01
200000002333
PHP
MI
05
4780821
MI
05
4864663
MI
01
7568238
AETNA
MI
01
P00254269
RAILROAD MEDICARE
MI
Enumeration date
06/08/2006
Last updated
01/14/2021
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