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General NPI Number Information
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NPI Number | 1427056027
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Entity Type | Organization
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Legal Business Name | D MICHAEL MAHAN MD PA
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 120 CHARLES D ROLLINS RD SUITE 105
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City | HENDERSON
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State | NC
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Zip | 27536-2882
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Country | US
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Telephone | 252-436-6543
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Fax | 252-436-2109
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Provider Business Mailing Address
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Address Line | 120 CHARLES D ROLLINS RD SUITE 105
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City | HENDERSON
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State | NC
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Zip | 27536-2882
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Country | US
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Telephone | 252-436-6543
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Fax | 252-436-2109
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Authorized Official
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Title or Position | CEO
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Name | DENNIS MICHAEL MAHAN
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Credential | M.D.
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Telephone | 919-693-7108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25053
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License Number State | NC
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