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General NPI Number Information
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NPI Number | 1487115010
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Entity Type | Individual
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Provider Name | MARIELLE MAHAN MD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 5612 SHIELDS DR
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City | BETHESDA
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State | MD
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Zip | 20817-3532
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Country | US
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Telephone | 301-571-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 11300 ROCKVILLE PIKE STE 1202
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City | ROCKVILLE
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State | MD
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Zip | 20852-3040
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Country | US
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Telephone | 301-896-0890
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Fax | 301-896-0968
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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 | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | D0103387
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | MD600004334
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD600004334
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0103387
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License Number State | MD
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