Provider Demographics
NPI:1427028554
Name:MAHONEY, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 4TH ST SW
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1596
Mailing Address - Country:US
Mailing Address - Phone:641-424-0000
Mailing Address - Fax:641-424-6762
Practice Address - Street 1:2800 4TH ST SW
Practice Address - Street 2:SUITE 8
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1596
Practice Address - Country:US
Practice Address - Phone:641-424-0000
Practice Address - Fax:641-424-6762
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27189OtherBLUE CROSS OF IOWA #
IA0029413Medicaid
IA0029413Medicaid
IAA03325Medicare UPIN
IA27189OtherBLUE CROSS OF IOWA #