MEDICARE: DR. MARK A TALAMINI 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	208600000X	Surgery Physician	C51961	CA
2	2086X0206X	Surgical Oncology Physician	C51961	CA
3	208600000X	Surgery Physician	272937	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588694673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A TALAMINI M.D.

Provider Business Mailing Address
First Line	:	HST 19 020
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	HST 19 020
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7875
Fax Number	:	631-444-8947

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/13/2013

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