Healthcare Provider Details

I. General information

NPI: 1063429561
Provider Name (Legal Business Name): JOHN F MAHONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 BALLANTYNE MEDICAL PLACE SUITE 200
CHARLOTTE NC
28277-3297
US

IV. Provider business mailing address

PO BOX 602120
CHARLOTTE NC
28260-2120
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-4000
  • Fax: 704-446-4098
Mailing address:
  • Phone: 704-446-4000
  • Fax: 704-446-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number34077
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number34077
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: