MEDICARE: SEAN M MAHAN MD

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	2085R0202X	Diagnostic Radiology Physician	0101228974	VA
2	2085R0202X	Diagnostic Radiology Physician	ME70745	FL
3	2085R0202X	Diagnostic Radiology Physician	MD21287	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063445963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN M MAHAN MD

Provider Business Mailing Address
First Line	:	2572 W STATE ROAD 426
Second Line	:	SUITE 2032
City	:	OVIEDO
State	:	FL
Zip	:	32765-8389
Country	:	US
Telephone Number	:	407-699-1100
Fax Number	:	407-218-8833

Provider Business Practice Location Address
First Line	:	2572 W STATE ROAD 426
Second Line	:	SUITE 2032
City	:	OVIEDO
State	:	FL
Zip	:	32765-8389
Country	:	US
Telephone Number	:	407-699-1100
Fax Number	:	407-218-8833

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/18/2009

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Directions to “ SEAN M MAHAN MD” Practice Location

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