Individual
MARY MAHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
642 S WALKER ST, BLOOMINGTON, IN 47403-2158
(812) 331-9160
(812) 336-0277
Mailing address
642 S WALKER ST, BLOOMINGTON, IN 47403-2158
(812) 331-9160
(812) 336-0277
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037667A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100184710
—
IN
Enumeration date
09/15/2005
Last updated
12/18/2020
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