Provider Demographics
NPI:1093274755
Name:MAHON MEDICAL INNOVATIONS INC
Entity Type:Organization
Organization Name:MAHON MEDICAL INNOVATIONS INC
Other - Org Name:MOVEMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-600-3476
Mailing Address - Street 1:18 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3240
Mailing Address - Country:US
Mailing Address - Phone:215-600-3476
Mailing Address - Fax:844-823-2597
Practice Address - Street 1:18 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3240
Practice Address - Country:US
Practice Address - Phone:215-600-3476
Practice Address - Fax:844-823-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103264248-0001Medicaid