Provider Demographics
NPI:1346763422
Name:MAHONEY, PAMELA MIRANDA (AGNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MIRANDA
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MIRANDA
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP
Mailing Address - Street 1:7556 TEAGUE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1969
Mailing Address - Country:US
Mailing Address - Phone:410-595-0182
Mailing Address - Fax:410-595-0182
Practice Address - Street 1:7556 TEAGUE RD STE 112
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1969
Practice Address - Country:US
Practice Address - Phone:410-595-0182
Practice Address - Fax:410-595-0182
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner