Individual
MARK T MAHONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 COLLEGE DRIVE, MARTINSVILLE, VA 24112
(276) 666-0500
(276) 666-0400
Mailing address
100 COLLEGE DRIVE, MARTINSVILLE, VA 24112
(276) 666-0500
(276) 666-0400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102201617
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00W138M01
MEDICARE
VA
05
—
010098467
—
VA
01
—
146677
ANTHEM
VA
01
—
283562
SOUTHERN HEALTH
VA
01
—
7547584
AETNA
VA
01
—
9960505
CIGNA
VA
Enumeration date
10/16/2007
Last updated
05/12/2015
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