Provider Demographics
NPI:1982677720
Name:GROVE-MAHONEY, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GROVE-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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041383L246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000126583OtherUNISON
PA30003495OtherKEYSTONE MERCY
PA50056056OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA5685185OtherAETNA-NON HMO
PA001489872Medicaid
PA0737893000OtherINDEPENDENCE BLUE CROSS
PA76907OtherGEISINGER
PA1537630OtherGATEWAY
PA000539004OtherHIGHMARK
PA20011072OtherMERCY
PA847766OtherAETNA-HMO
PA220021412OtherRR MEDICARE
PAE98606Medicare UPIN
PA539004Medicare ID - Type Unspecified