Provider Demographics
NPI:1376507475
Name:MAHAFFEY, ANDREW GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GLENN
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:1900 SCENIC DR
Practice Address - Street 2:SUITE 3326
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7724
Practice Address - Country:US
Practice Address - Phone:512-863-6850
Practice Address - Fax:512-688-5477
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131664802Medicaid
TXG5326OtherLICENSE
TX00T54EMedicare ID - Type Unspecified
TX131664802Medicaid