Provider Demographics
NPI:1881947620
Name:MIKE MAHONY, MD, LLC
Entity type:Organization
Organization Name:MIKE MAHONY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAHONY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:504-858-4740
Mailing Address - Street 1:3500 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3527
Mailing Address - Country:US
Mailing Address - Phone:504-838-9919
Mailing Address - Fax:
Practice Address - Street 1:3500 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 1410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3527
Practice Address - Country:US
Practice Address - Phone:504-838-9919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG02170Medicare UPIN