Individual
JOHN MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5057
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
CLP05918
RI
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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