Provider Demographics
NPI:1225282585
Name:MAHAN, SETH GREGORY (PA-C)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:GREGORY
Last Name:MAHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-442-6365
Mailing Address - Fax:302-633-3350
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-442-6365
Practice Address - Fax:302-633-3350
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000644207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00751423OtherRAILROAD MEDICARE
147209ZC2LMedicare PIN