Provider Demographics
NPI:1275613390
Name:MATHALON, DANIEL HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HENRY
Last Name:MATHALON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4150 CLEMENT ST
Mailing Address - Street 2:MENTAL HEALTH 116D, SFVAMC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1545
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:415-750-6622
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:MENTAL HEALTH 116D, SFVAMC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-02-26
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Provider Licenses
StateLicense IDTaxonomies
CT0393582084P0800X
CALA551332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry