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NPI Code Detail

MEDICARE: DR. BILLY WADE MAHANEY M.D.

MEDICARE: DR. BILLY WADE MAHANEY 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
12085R0204XVascular & Interventional Radiology PhysicianD0075283MD
22085R0204XVascular & Interventional Radiology PhysicianM8806TX
32085R0202XDiagnostic Radiology PhysicianMD22871ME

Other Identifiers

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

General Provider Information

NPI Number : 1457342966
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BILLY WADE MAHANEY M.D.
Provider Business Mailing Address
First Line : 157 PRINCES POINT RD
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-3729
Country : US
Telephone Number : 201-867-6427
Fax Number :
Provider Business Practice Location Address
First Line : 123 MEDICAL CENTER DR
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2652
Country : US
Telephone Number : 207-373-6838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 05/21/2023

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