Provider Demographics
NPI:1326163239
Name:MAHON, KANCHAN M (MD)
Entity Type:Individual
Prefix:
First Name:KANCHAN
Middle Name:M
Last Name:MAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5758
Mailing Address - Country:US
Mailing Address - Phone:607-748-9900
Mailing Address - Fax:607-748-9800
Practice Address - Street 1:3220 PEARL ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5758
Practice Address - Country:US
Practice Address - Phone:607-748-9900
Practice Address - Fax:607-748-9800
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2114832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry