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General NPI Number Information
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NPI Number | 1003871898
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Entity Type | Individual
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Provider Name | CORINNE MAHONEY PA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 111 BROOKLINE AVE
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City | BOSTON
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State | MA
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Zip | 02215-3903
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Country | US
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Telephone | 617-421-1000
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Fax | 617-421-6084
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Provider Business Mailing Address
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Address Line | 41 RESNIK RD
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City | PLYMOUTH
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State | MA
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Zip | 02360-4842
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Country | US
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Telephone | 781-934-2400
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Fax | 781-934-3930
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1006
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1006
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License Number State | MA
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