Provider Demographics
NPI:1740255066
Name:MAHONEY, ROBERT K (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:520 BELEM DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8038
Mailing Address - Country:US
Mailing Address - Phone:757-618-2092
Mailing Address - Fax:
Practice Address - Street 1:NMCP, PORTSMOUTH
Practice Address - Street 2:620 JOHN PAUL JONES CIRCLE
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-953-6366
Practice Address - Fax:757-953-6378
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101042244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0056101100Medicaid
VA0056101100Medicaid