Provider Demographics
NPI:1245285204
Name:MAHONEY, MARY (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
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 1:3200 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-584-3663
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:ML 0772
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-1000
Practice Address - Country:US
Practice Address - Phone:513-584-5335
Practice Address - Fax:584-584-3663
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-46122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1621098OtherUHC
OH000000013495OtherANTHEM
IL200129330AMedicaid
OH0701226Medicaid
OH645406OtherAETNA
KY64860372Medicaid
OH1621098OtherUHC
OHH052810Medicare PIN