Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD449022 | PA |
NPI | 1003137332 |
---|---|
Provider Name | Heather Denean Mahoney |
First Address | Wynnewood, PA 19096-2139 |
Second Address | Wynnewood, PA 19096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 15/06/2018 |