Provider Demographics
NPI:1992863062
Name:WILLIAM MAHON, MD PC
Entity Type:Organization
Organization Name:WILLIAM MAHON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-343-3992
Mailing Address - Street 1:140 W 6TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2525
Mailing Address - Country:US
Mailing Address - Phone:315-343-3992
Mailing Address - Fax:315-343-1455
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-343-3992
Practice Address - Fax:315-343-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1423231207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB81825Medicare UPIN