Individual
TRACI L. MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
545 RAY C HUNT DR STE 140, CHARLOTTESVILLE, VA 22903
(434) 243-0245
(434) 243-0242
Mailing address
300 HICKMAN RD STE 202, CHARLOTTESVILLE, VA 22911-3554
(434) 326-5815
(434) 326-5820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006132
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03427667
—
NY
05
—
1376829184
—
VA
Enumeration date
10/25/2011
Last updated
02/18/2023
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