Provider Demographics
NPI:1114080116
Name:MAHONEY, JAMES JOSEPH (MD CM)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 CROWN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0913
Mailing Address - Country:US
Mailing Address - Phone:857-403-4600
Mailing Address - Fax:
Practice Address - Street 1:695 TRUMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136
Practice Address - Country:US
Practice Address - Phone:617-364-4385
Practice Address - Fax:617-364-7363
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2059711Medicaid
MA2059711Medicaid
B98711Medicare UPIN