MEDICARE: DR. MOHAMED AHMED ELDARDIRI ISMAIL ALY MD, MB BCH MSC MRCS

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	1801095237	TX
2	208600000X	Surgery Physician	326279	NY
3	2086S0122X	Plastic and Reconstructive Surgery Physician	326279	NY
4	208200000X	Plastic Surgery Physician	326279	NY

General Provider Information

NPI Number	:	1932579851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED AHMED ELDARDIRI ISMAIL ALY MD, MB BCH MSC MRCS

Provider Business Mailing Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE D
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3064
Country	:	US
Telephone Number	:	315-464-8224
Fax Number	:	315-464-2187

Provider Business Practice Location Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE D
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3064
Country	:	US
Telephone Number	:	315-464-8224
Fax Number	:	315-464-2187

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

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	12/06/2023

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