Provider Demographics
NPI:1326620923
Name:MAHONEY, DANIEL JAMES BLAKE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES BLAKE
Last Name:MAHONEY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:4 SILVERSTEIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-615-4949
Mailing Address - Fax:215-662-2244
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:4 SILVERSTEIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-615-4949
Practice Address - Fax:215-662-2244
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-10-21
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Provider Licenses
StateLicense IDTaxonomies
PAMA062063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant