MEDICARE: CORINNE MAHONEY PA

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	363AM0700X	Medical Physician Assistant	1006	MA
2	363A00000X	Physician Assistant	1006	MA

General Provider Information

NPI Number	:	1003871898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE MAHONEY PA

Provider Business Mailing Address
First Line	:	41 RESNIK RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4842
Country	:	US
Telephone Number	:	781-934-2400
Fax Number	:	781-934-3930

Provider Business Practice Location Address
First Line	:	111 BROOKLINE AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-3903
Country	:	US
Telephone Number	:	617-421-1000
Fax Number	:	617-421-6084

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	06/29/2020

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Directions to “ CORINNE MAHONEY PA” Practice Location

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