Healthcare Provider Details

I. General information

NPI: 1801322334
Provider Name (Legal Business Name): BRENDAN MAHON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E. MARSHALL STREET BOX 980401
RICHMOND VA
23298
US

IV. Provider business mailing address

1013 W MOUNT VERNON AVE
HADDONFIELD NJ
08033-3038
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax:
Mailing address:
  • Phone: 609-941-1728
  • Fax:

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 State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB10832000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: