Provider Demographics
NPI:1730555426
Name:THOMAS L MAHONEY, MD, PLLC
Entity type:Organization
Organization Name:THOMAS L MAHONEY, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-6888
Mailing Address - Street 1:617 23RD ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2880
Mailing Address - Country:US
Mailing Address - Phone:606-325-6888
Mailing Address - Fax:606-326-9368
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 415
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-325-6888
Practice Address - Fax:606-326-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09566OtherUPIN