Provider Demographics
NPI:1528176682
Name:DISHMAN, LEONARDO (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:DISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1220
Mailing Address - Country:US
Mailing Address - Phone:518-481-6434
Mailing Address - Fax:516-481-2366
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1220
Practice Address - Country:US
Practice Address - Phone:518-481-6434
Practice Address - Fax:516-481-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160893207ZB0001X, 207ZC0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52653BMedicare PIN
E63242Medicare UPIN