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Individual

HARRY WALLACE MAHOOD JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1 LAWRENCE ST, CENTER FOR CHILDREN & FAMILIES, GLENS FALLS, NY 12801-3617
(518) 926-7100
(518) 926-7069
Mailing address
100 PARK ST, GLENS FALLS HOSPITAL, GLENS FALLS, NY 12801-4413
(518) 926-3210
(518) 926-3215

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
205334
NY
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
205334
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00987929
RR MEDICARE
NY
Enumeration date
10/17/2005
Last updated
06/13/2012
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