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General NPI Number Information
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NPI Number | 1033788237
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Entity Type | Individual
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Provider Name | BENJAMIN JOSEPH MAHONEY DNP, APRN
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Gender | Male
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 160 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4560
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Country | US
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Telephone | 802-775-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 1 LONG WHARF DR STE 321
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City | NEW HAVEN
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State | CT
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Zip | 06511-5946
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Country | US
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Telephone | 203-781-4600
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 009732
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 101.0137520
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License Number State | VT
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