Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MB50026 | NJ |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OS005339L | PA |
NPI | 1235182692 |
---|---|
Provider Name | Dr. Nola T. Mahoney |
First Address | Southampton, PA 18966-4218 |
Second Address | Hamilton, NJ 08619-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E13296 | (02) | NJ |