Provider Demographics
NPI:1073513271
Name:DHAMOON, SURJIT K (MD)
Entity Type:Individual
Prefix:
First Name:SURJIT
Middle Name:K
Last Name:DHAMOON
Suffix:
Gender:F
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 2001
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4501
Mailing Address - Country:US
Mailing Address - Phone:315-449-2208
Mailing Address - Fax:315-362-5120
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5841
Practice Address - Fax:315-492-5843
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1646122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB1265Medicare PIN
B82719Medicare UPIN
NYRB1265Medicare PIN