Provider Demographics
NPI:1639137383
Name:MAHONEY, MICHELE V (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:V
Last Name:MAHONEY
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 1:4335 W. DUBLIN- GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-889-7772
Mailing Address - Fax:614-764-0843
Practice Address - Street 1:444 N. CLEVELAND AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-889-7772
Practice Address - Fax:614-899-9964
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350811272080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273180Medicaid