Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 35050467 | OH |
NPI | 1023002417 |
---|---|
Provider Name | John Donald Mahan |
First Address | Columbus, OH 43205-2654 |
Second Address | Columbus, OH 43205-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 06/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105365000 | (05) | WV |
0562529 | (05) | OH |
64789340 | (05) | KY |
C02764 | (02) |