MEDICARE: MAMOON DAAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	211266	NY
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	211266	NY
3	207Q00000X	Family Medicine Physician	211266	NY

General Provider Information

NPI Number	:	1053318576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMOON DAAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:	518-649-4094

Provider Business Practice Location Address
First Line	:	326 S PEARL ST
Second Line	:	ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
City	:	ALBANY
State	:	NY
Zip	:	12202-1914
Country	:	US
Telephone Number	:	518-449-0100
Fax Number	:	518-463-8580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/10/2021

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