Healthcare Provider Details

I. General information

NPI: 1417881483
Provider Name (Legal Business Name): MATTHEW MAHONEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CENTRE ST STE 108
NEWTON CENTRE MA
02459-2578
US

IV. Provider business mailing address

5 WASHINGTON ST APT 409
BRIGHTON MA
02135-7458
US

V. Phone/Fax

Practice location:
  • Phone: 161-796-5740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: