Provider Demographics
NPI:1073559183
Name:MAHONEY, PATRICK D (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:ALEGENT LAKESIDE HOSPITAL DEPT OF RADIOLOGY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:404-717-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE122982085R0202X
IA187072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00093OtherBCBS
IA5973305Medicaid
IA7973305Medicaid
IA6973305Medicaid
1601606OtherUHC SHARE ALLIANCE
IA8973305Medicaid
BM6826513OtherIA CONTROLLED SUBSTANCE
13705OtherMIDLANDS
IA17831OtherBCBS
IA2973305Medicaid
1600520OtherUHC SHARE ALLIANCE
1600520OtherUHC SHARE ALLIANCE
D09059Medicare UPIN
NENA1355008Medicare PIN
AM6984339OtherDEA #
BM6826513OtherIA CONTROLLED SUBSTANCE
NENA1356008Medicare PIN
13705OtherMIDLANDS
IA17831Medicare PIN