Provider Demographics
NPI:1063445963
Name:MAHAN, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:MAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 W STATE ROAD 426
Mailing Address - Street 2:SUITE 2032
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8389
Mailing Address - Country:US
Mailing Address - Phone:407-699-1100
Mailing Address - Fax:407-218-8833
Practice Address - Street 1:2572 W STATE ROAD 426
Practice Address - Street 2:SUITE 2032
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-699-1100
Practice Address - Fax:407-218-8833
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012289742085R0202X
FLME707452085R0202X
DCMD212872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010217849Medicaid
FL266823800Medicaid
VAG34585Medicare UPIN
VA010217849Medicaid