Provider Demographics
NPI:1700816592
Name:O'MAHONEY, BRIAN T (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:O'MAHONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NE 45TH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5136
Mailing Address - Country:US
Mailing Address - Phone:954-493-5005
Mailing Address - Fax:
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-771-8000
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14497207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOM4185821OtherMEDICARE ID-TYPE UNSPECIFIED
OH2667476Medicaid
OHI55372Medicare UPIN
OHOM4185821Medicare PIN