Provider Demographics
NPI:1417921818
Name:MAHON, ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
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 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2203 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4205
Practice Address - Country:US
Practice Address - Phone:757-583-2181
Practice Address - Fax:757-480-6482
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4085864OtherAETNA
VA010005523Medicaid
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA463070OtherANTHEM
VA541595397OtherCIGNA
VA541595397OtherTRICARE
VA541595397OtherMID ATLANTIC SOLUTIONS
VA66217OtherSENTARA/OPTIMA
VAC47160Medicare UPIN
VA541595397OtherMID ATLANTIC SOLUTIONS