Provider Demographics
NPI:1003137332
Name:MAHONEY, HEATHER DENEAN (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENEAN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DENEAN
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E LANCASTER AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2139
Mailing Address - Country:US
Mailing Address - Phone:610-642-2002
Mailing Address - Fax:610-642-7607
Practice Address - Street 1:300 E LANCASTER AVE STE 400
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-642-2002
Practice Address - Fax:610-642-7607
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449022207Q00000X
PAMT196809390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program