Healthcare Provider Details

I. General information

NPI: 1538165378
Provider Name (Legal Business Name): STEPHEN JAMES MAHONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 200
INDIANAPOLIS IN
46237-8632
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 200
INDIANAPOLIS IN
46237-8632
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-2955
  • Fax: 317-865-2944
Mailing address:
  • Phone: 317-865-2955
  • Fax: 317-865-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01026306
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: