Provider Demographics
NPI:1457668147
Name:MAHON, HIROMI (MD)
Entity Type:Individual
Prefix:
First Name:HIROMI
Middle Name:
Last Name:MAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:SUITE 2 WEST
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-347-5400
Mailing Address - Fax:518-347-5222
Practice Address - Street 1:1444 WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3458
Practice Address - Country:US
Practice Address - Phone:518-533-6710
Practice Address - Fax:518-533-6711
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY270882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03629738Medicaid