Provider Demographics
NPI:1477223436
Name:MAHAN, DAVID PATRICK
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:MAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-3148
Mailing Address - Country:US
Mailing Address - Phone:304-559-6529
Mailing Address - Fax:
Practice Address - Street 1:45 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-3148
Practice Address - Country:US
Practice Address - Phone:304-559-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant