Provider Demographics
NPI:1104021278
Name:DHAMOON, AMIT S (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:S
Last Name:DHAMOON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:SUNY UPSTATE MEDICAL UNIVERSITY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-5774
Mailing Address - Fax:315-464-1937
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:SUNY UPSTATE MEDICAL UNIVERSITY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5774
Practice Address - Fax:315-464-1937
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259553208M00000X
NY259583-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370647Medicaid
NYP01069350Medicare PIN
NYJ400052970Medicare PIN