Healthcare Provider Details

I. General information

NPI: 1174548424
Provider Name (Legal Business Name): MEGAN E MAHAFFEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

IV. Provider business mailing address

752 N HIGH POINT RD
MADISON WI
53717-2236
US

V. Phone/Fax

Practice location:
  • Phone: 608-824-4800
  • Fax: 608-824-4929
Mailing address:
  • Phone: 608-824-4800
  • Fax: 608-824-4929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46848-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: