Provider Demographics
NPI:1184867814
Name:MAHONEY, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:916-564-0521
Mailing Address - Fax:877-860-2907
Practice Address - Street 1:7777 SUNRISE BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2300
Practice Address - Country:US
Practice Address - Phone:916-722-2227
Practice Address - Fax:877-860-5422
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2016-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA54815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01463667-EFF3/18/15OtherRAILROAD MEDICARE-DV5277
CAEFFECTIVE- 1/22/2015Medicaid
CAEFFECTIVE- 1/22/2015Medicaid