MEDICARE: DR. THOMAS LANG MAHONEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	142554	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0977	OTHER	NY	BCBS NUMBER
2	142554	OTHER	NY	LISCENSE
3	010142554	OTHER	NY	BLUE CHOICE
4	187A	OTHER	NY	PREFERRED CARE ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	CIM 231398	OTHER	NY	WORKERS COMP NUMBER

General Provider Information

NPI Number	:	1235166414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LANG MAHONEY M.D.

Provider Business Mailing Address
First Line	:	39 ROCK CREEK RD
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-2841
Country	:	US
Telephone Number	:	585-586-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	3875 E HENRIETTA RD
Second Line	:
City	:	HENRIETTA
State	:	NY
Zip	:	14467-9147
Country	:	US
Telephone Number	:	585-334-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	03/07/2023

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