Healthcare Provider Details

I. General information

NPI: 1982697520
Provider Name (Legal Business Name): THOMAS M MAHANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

311 SOUTH 15TH STREET SUITE 101
COSHOCTON OH
43812-0457
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7123
  • Fax: 855-855-2792
Mailing address:
  • Phone: 740-622-0799
  • Fax: 740-622-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35078490
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35078490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: