Provider Demographics
NPI:1811937451
Name:MAHMOOD, TALLAT (MD)
Entity type:Individual
Prefix:DR
First Name:TALLAT
Middle Name:
Last Name:MAHMOOD
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 1:251 SALINA MEADOWS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2014
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-8200
Practice Address - Fax:315-464-8289
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077088207RH0003X
NY308286207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4864663Medicaid
MI1103312201OtherBCBS/BCN
MI1017788OtherMCLAREN HEALTH PLAN-MEDICAID
MI200000002333OtherPHP
MI4780821Medicaid
MI200000002333OtherPHP FAMILYCARE
MI7568238OtherAETNA
MIP00254269OtherRAILROAD MEDICARE
MI0M76680004OtherMEDICARE ADVANTAGE
MI1017788OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1017788OtherMCLAREN HEALTH ADVANTAGE
MI200000002333OtherPHP
MIP00254269OtherRAILROAD MEDICARE