Provider Demographics
NPI:1255320909
Name:MAHOOD, HARRY WALLACE JR (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:WALLACE
Last Name:MAHOOD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:GLENS FALLS HOSPITAL
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-3210
Mailing Address - Fax:518-926-3215
Practice Address - Street 1:1 LAWRENCE ST
Practice Address - Street 2:CENTER FOR CHILDREN & FAMILIES
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3617
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:518-926-7069
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2053342084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00987929OtherRR MEDICARE
NYRA4894Medicare PIN
NYP00987929OtherRR MEDICARE
NYRA4512Medicare PIN