MEDICARE: HEATHER DENEAN MAHONEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD449022	PA

General Provider Information

NPI Number	:	1003137332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DENEAN MAHONEY M.D.

Provider Business Mailing Address
First Line	:	300 E LANCASTER AVE STE 400
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-2139
Country	:	US
Telephone Number	:	610-642-2002
Fax Number	:	610-642-7607

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE STE 353
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3433
Country	:	US
Telephone Number	:	445-216-3374
Fax Number	:	610-642-2802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	05/30/2024

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