Healthcare Provider Details

I. General information

NPI: 1073559183
Provider Name (Legal Business Name): PATRICK D MAHONEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16901 LAKESIDE HILLS CT ALEGENT LAKESIDE HOSPITAL DEPT OF RADIOLOGY
OMAHA NE
68130-2318
US

IV. Provider business mailing address

PO BOX 4460
OMAHA NE
68104
US

V. Phone/Fax

Practice location:
  • Phone: 404-717-8146
  • Fax:
Mailing address:
  • Phone: 866-491-5807
  • Fax: 913-491-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12298
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18707
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: