Provider Demographics
NPI:1467712679
Name:MAHANEY, PATRICK JAMES (RD, LDN)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JAMES
Last Name:MAHANEY
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MACGREGOR PINES DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6036
Mailing Address - Country:US
Mailing Address - Phone:919-234-4880
Mailing Address - Fax:
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-234-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001938133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL001938OtherNORTH CAROLINA BOARD OF DIETETICS/NUTRITION
877917OtherCOMMISSION ON DIETETIC REGISTRATION