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General NPI Number Information
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NPI Number | 1164508388
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Entity Type | Individual
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Provider Name | MAMADOU DIALLO MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 276-280 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1659
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Country | US
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Telephone | 607-722-2769
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Fax | 607-772-2095
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Provider Business Mailing Address
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Address Line | 276-280 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1659
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Country | US
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Telephone | 607-722-2769
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Fax | 607-772-2095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101237298
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 236205-1
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 236205
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License Number State | NY
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