Provider Demographics
NPI:1053318576
Name:DAAS, MAMOON (MD)
Entity Type:Individual
Prefix:
First Name:MAMOON
Middle Name:
Last Name:DAAS
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 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:326 S PEARL ST
Practice Address - Street 2:ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1914
Practice Address - Country:US
Practice Address - Phone:518-449-0100
Practice Address - Fax:518-463-8580
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211266207R00000X, 207ZP0102X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96750Medicare UPIN
NYDD4047Medicare ID - Type Unspecified