Provider Demographics
NPI:1295090421
Name:MAHONEY, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 OBSERVATION DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4086
Mailing Address - Country:US
Mailing Address - Phone:301-873-7214
Mailing Address - Fax:
Practice Address - Street 1:20400 OBSERVATION DR STE 103
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4086
Practice Address - Country:US
Practice Address - Phone:301-873-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical