Provider Demographics
NPI:1356456149
Name:MAHLO, RONALD C (NP-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:MAHLO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:423-339-0300
Mailing Address - Fax:423-472-5687
Practice Address - Street 1:2390 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3850
Practice Address - Country:US
Practice Address - Phone:423-339-0300
Practice Address - Fax:423-709-0543
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ72152Medicare UPIN
GA50BBKQQMedicare ID - Type UnspecifiedGA-MEDICARE