Healthcare Provider Details

I. General information

NPI: 1477550473
Provider Name (Legal Business Name): DENNIS MICHAEL MAHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 COLLEGE ST
OXFORD NC
27565-2507
US

IV. Provider business mailing address

PO BOX 986
OXFORD NC
27565-0986
US

V. Phone/Fax

Practice location:
  • Phone: 919-693-6541
  • Fax: 919-693-7396
Mailing address:
  • Phone: 919-690-3487
  • Fax: 919-690-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25053
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25053
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: