Basic Information
| Provider Information | |||||||||
| NPI: | 1255320909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHOOD | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | WALLACE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARK ST | ||||||||
| Address2: | GLENS FALLS HOSPITAL | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189263210 | ||||||||
| FaxNumber: | 5189263215 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LAWRENCE ST | ||||||||
| Address2: | CENTER FOR CHILDREN & FAMILIES | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128013617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189267100 | ||||||||
| FaxNumber: | 5189267069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 205334 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 205334 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | P00987929 | 01 | NY | RR MEDICARE | OTHER |