Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 0101237610 | VA |
NPI | 1427062207 |
---|---|
Provider Name | Dr. Samuel M. Mahaffey |
First Address | Baltimore, MD 21263-1617 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1702645 | UNITED HEATLH CARE (01) | VA |
174614 | ANTHEM BCBS (01) | VA |
2134227 | ALLIANCE & MDIPA (01) | VA |
2134227 | MAMSI/OPTIMUM CHOICE (01) | VA |
3116108340002E | CIGNA (01) | VA |
8953736 | NORTH CAROLINA MEDICAID (01) | VA |
92534 | OPTIMA/SENTARA HEALTH (01) | VA |
D65724 | (02) | VA |