Provider Demographics
NPI:1275604282
Name:MAHAN, DENNIS WILLIAM (PA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:WILLIAM
Last Name:MAHAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:157 WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1947
Mailing Address - Country:US
Mailing Address - Phone:717-679-7221
Mailing Address - Fax:
Practice Address - Street 1:BLDG 11-59
Practice Address - Street 2:FORT INDIANTOWN GAP
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-5002
Practice Address - Country:US
Practice Address - Phone:717-861-2622
Practice Address - Fax:717-861-2655
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA002024L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant