Healthcare Provider Details

I. General information

NPI: 1558369611
Provider Name (Legal Business Name): HARRY C ODABASHIAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVENUE SUITE 200
ALBANY NY
12206
US

IV. Provider business mailing address

1365 WASHINGTON AVENUE SUITE 200
ALBANY NY
12206
US

V. Phone/Fax

Practice location:
  • Phone: 518-264-1800
  • Fax: 518-264-1815
Mailing address:
  • Phone: 518-264-1800
  • Fax: 518-264-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number120407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: