MEDICARE: MARIELLE MAHAN MD

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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	D0103387	MD
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	MD600004334	DC
3	207W00000X	Ophthalmology Physician	MD600004334	DC
4	207W00000X	Ophthalmology Physician	D0103387	MD

General Provider Information

NPI Number	:	1487115010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELLE MAHAN MD

Provider Business Mailing Address
First Line	:	11300 ROCKVILLE PIKE STE 1202
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-3040
Country	:	US
Telephone Number	:	301-896-0890
Fax Number	:	301-896-0968

Provider Business Practice Location Address
First Line	:	5612 SHIELDS DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3532
Country	:	US
Telephone Number	:	301-571-4334
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	10/02/2025

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Directions to “ MARIELLE MAHAN MD” Practice Location

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