Provider Demographics
NPI:1558369611
Name:ODABASHIAN, HARRY C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:C
Last Name:ODABASHIAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1365 WASHINGTON AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206
Mailing Address - Country:US
Mailing Address - Phone:518-264-1800
Mailing Address - Fax:518-264-1815
Practice Address - Street 1:1365 WASHINGTON AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206
Practice Address - Country:US
Practice Address - Phone:518-264-1800
Practice Address - Fax:518-264-1815
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY120407207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00396369Medicaid
VT1000435Medicaid
NYRA2968Medicare PIN
NY00396369Medicaid