Provider Demographics
NPI:1508896358
Name:O'MAHONY, RUTH ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ELLEN
Last Name:O'MAHONY
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 1:897 W MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4466
Mailing Address - Fax:
Practice Address - Street 1:897 W MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1029
Practice Address - Country:US
Practice Address - Phone:207-564-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93215208600000X
NH13223208600000X
ME018008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00654554OtherRAILROAD MEDICARE
ME000587801OtherMEDICARE PTAN
I35756Medicare UPIN