Healthcare Provider Details

I. General information

NPI: 1780188680
Provider Name (Legal Business Name): DEVON MAHONEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVON DREW MD

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

2050 RIVER PEARL WAY
CHESAPEAKE VA
23321-3773
US

V. Phone/Fax

Practice location:
  • Phone: 579-535-0087
  • Fax:
Mailing address:
  • Phone: 770-241-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2019-02437
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2019-02437
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number2019-02437
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: