Provider Demographics
NPI:1124670781
Name:TALLON DE LARA, PAULINO (MD, PHD)
Entity type:Individual
Prefix:
First Name:PAULINO
Middle Name:
Last Name:TALLON DE LARA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TENTH AVENUE
Mailing Address - Street 2:MOUNT SINAI WEST, DEPARTMENT OF MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-259-6777
Mailing Address - Fax:
Practice Address - Street 1:1000 TENTH AVENUE
Practice Address - Street 2:MOUNT SINAI WEST, DEPARTMENT OF MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-259-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program