Healthcare Provider Details

I. General information

NPI: 1124610928
Provider Name (Legal Business Name): PATRICK MICHAEL MAHON ACNPC-AG, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 BUTLER RD STE 2A
GLYNDON MD
21136-5688
US

IV. Provider business mailing address

4821 BUTLER RD STE 2A
GLYNDON MD
21136-5688
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-0182
  • Fax: 410-297-0728
Mailing address:
  • Phone: 410-449-0182
  • Fax: 410-297-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR224708
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR224708
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR224708
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: