Healthcare Provider Details

I. General information

NPI: 1871911230
Provider Name (Legal Business Name): JENNIFER B MAHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/09/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8364 BELL CREEK ROAD
MECHANICSVILLE VA
23116
US

IV. Provider business mailing address

7130 GLEN FOREST DR STE 101
RICHMOND VA
23226-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-4084
  • Fax: 804-559-2046
Mailing address:
  • Phone: 804-662-6138
  • Fax: 804-559-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS15300
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102208270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: