Provider Demographics
NPI:1558914770
Name:MAHONEY, GAVIN CHARLES
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:CHARLES
Last Name:MAHONEY
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 1:5454 WISCONSIN AVE STE 1535
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6922
Mailing Address - Country:US
Mailing Address - Phone:301-652-8847
Mailing Address - Fax:301-652-3751
Practice Address - Street 1:1145 19TH ST NW STE 402
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3716
Practice Address - Country:US
Practice Address - Phone:301-652-8847
Practice Address - Fax:202-331-1656
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01453231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist