Individual
ELLEN MAHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2203 E LITTLE CREEK RD, NORFOLK, VA 23518-4205
(757) 583-2181
(757) 480-6482
Mailing address
3241 WESTERN BRANCH BLVD, CHESAPEAKE, VA 23321-5260
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101038508
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010005523
—
VA
01
—
4085864
AETNA
VA
01
—
463070
ANTHEM
VA
01
—
541595397
VIRGINIA HEALTH NETWORK
VA
01
—
66217
SENTARA/OPTIMA
VA
Enumeration date
02/14/2006
Last updated
04/12/2010
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