Provider Demographics
NPI:1104021278
Name:DHAMOON, AMIT S (MD)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:S
Last Name:DHAMOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP
Mailing Address - Street 2:750 EAST ADAMS ST., 3RD FLR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5240
Mailing Address - Fax:315-464-1937
Practice Address - Street 1:DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP
Practice Address - Street 2:750 EAST ADAMS ST., 3RD FLR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5240
Practice Address - Fax:315-464-1937
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY259583-1207R00000X
NY259553208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370647Medicaid
NYP01069350Medicare PIN
NYJ400052970Medicare PIN