Provider Demographics
NPI:1336339472
Name:MAHONEY, ELLEN M (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PELHAM ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2625
Mailing Address - Country:US
Mailing Address - Phone:508-358-2918
Mailing Address - Fax:508-358-6054
Practice Address - Street 1:73 PELHAM ISLAND RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2625
Practice Address - Country:US
Practice Address - Phone:508-358-2918
Practice Address - Fax:508-358-6054
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics