MEDICARE: DALIA ELDEIRY MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	231094	NY

General Provider Information

NPI Number	:	1639169667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALIA ELDEIRY MD

Provider Business Mailing Address
First Line	:	PO BOX 884
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-0884
Country	:	US
Telephone Number	:	518-786-1296
Fax Number	:	518-786-1293

Provider Business Practice Location Address
First Line	:	2215 BURDETT AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-2466
Country	:	US
Telephone Number	:	518-271-3229
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	09/26/2018

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