Provider Demographics
NPI:1245961119
Name:DILLABOUGH, MADALYN MAE (PA)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:MAE
Last Name:DILLABOUGH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-2552
Mailing Address - Country:US
Mailing Address - Phone:315-212-1273
Mailing Address - Fax:
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant