Provider Demographics
NPI:1316140791
Name:MAHONEY DERMATOLOGY SPECIALISTS PA
Entity type:Organization
Organization Name:MAHONEY DERMATOLOGY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-452-3889
Mailing Address - Street 1:7995 66TH ST N STE B
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2163
Mailing Address - Country:US
Mailing Address - Phone:727-530-0920
Mailing Address - Fax:727-827-7139
Practice Address - Street 1:7995 66TH ST N STE B
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2163
Practice Address - Country:US
Practice Address - Phone:727-530-0920
Practice Address - Fax:727-827-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88148207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF716Medicare PIN