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NPI Code Detail

MEDICARE: JEDIDIAH AARON MAHAN

MEDICARE: JEDIDIAH AARON MAHAN
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
1208000000XPediatrics Physician310546NC

General Provider Information

NPI Number : 1154061216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEDIDIAH AARON MAHAN
Provider Business Mailing Address
First Line : 2301 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4699
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 234 CROOKED CREEK PKWY
Second Line :
City : DURHAM
State : NC
Zip : 27713-8505
Country : US
Telephone Number : 919-620-5333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2022
Last Update Date : 03/02/2026

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Directions to “ JEDIDIAH AARON MAHAN ” Practice Location

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