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General NPI Number Information
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NPI Number | 1114328903
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Entity Type | Organization
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Legal Business Name | MAHONEYMOBILEMEDICAL AND VASCULAR ACCESS SERVICE
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 716 FIRESTONE DR SUITE 1
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City | SILVER SPRING
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State | MD
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Zip | 20905-4087
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Country | US
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Telephone | 301-421-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 716 FIRESTONE DR MAHONEYMOBILEMEDICAL AND VASCULAR ACCESS SERVICE
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City | SILVER SPRING
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State | MD
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Zip | 20905-4087
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Country | US
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Telephone | 301-421-0800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEAN MAHONEY WILLIAMS
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Credential | M.D
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Telephone | 301-421-0800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD20371
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License Number State | MD
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