Organization
CARDIAC AND VASCULAR ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVYN V MAHON M.D. (MEMBER)
(803) 730-6790
Entity
Organization
Contact information
Practice address
1851 MESQUITE AVE, SUITE 202, LAKE HAVASU CITY, AZ 86403-5677
(928) 855-5090
(928) 855-9227
Mailing address
301 NORTHLAKE RD, COLUMBIA, SC 29223-6009
(803) 730-6790
(803) 736-5536
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L1560391-7
CORPORATION NUMBER
AZ
Enumeration date
11/02/2009
Last updated
11/02/2009
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