Provider Demographics
NPI:1245521731
Name:MAHLE, CAMERON PAUL (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:PAUL
Last Name:MAHLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 BROADWAY
Mailing Address - Street 2:OFFICE 905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3211
Mailing Address - Country:US
Mailing Address - Phone:347-943-0565
Mailing Address - Fax:
Practice Address - Street 1:1270 BROADWAY
Practice Address - Street 2:OFFICE 905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3211
Practice Address - Country:US
Practice Address - Phone:347-943-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2782762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry