Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 60136 | MA |
NPI | 1174586952 |
---|---|
Provider Name | Kathleen A Mahoney |
First Address | Springfield, MA 01107-1270 |
Second Address | Springfield, MA 01107-1270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3194621 | (05) | MA |
E60137 | (02) |