Provider Demographics
NPI:1932579851
Name:ISMAIL ALY, MOHAMED AHMED ELDARDIRI (MD, MB BCH MSC MRCS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:AHMED ELDARDIRI
Last Name:ISMAIL ALY
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Gender:M
Credentials:MD, MB BCH MSC MRCS
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Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3064
Mailing Address - Country:US
Mailing Address - Phone:315-464-8224
Mailing Address - Fax:315-464-2187
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE D
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3064
Practice Address - Country:US
Practice Address - Phone:315-464-8224
Practice Address - Fax:315-464-2187
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2023-12-06
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Provider Licenses
StateLicense IDTaxonomies
TX1801095237208600000X
NY326279208600000X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery