Provider Demographics
NPI:1386727857
Name:MAHONEY, MARY (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
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 1:420 DELAWARE ST SE, MMC 395
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-7111
Mailing Address - Fax:
Practice Address - Street 1:606 24TH AVE S, SUITE 300
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43322207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
07-00036OtherMEDICA PRIMARY
127306OtherUCARE
1398216OtherARAZ
WI34291300Medicaid
1028622OtherPREFERRED ONE
HP33841OtherHEALTH PARTNERS
07-02917OtherMEDICA CHOICE
MN579030100Medicaid
MT0062186Medicaid
IA0557470Medicaid
249J0MAOtherBLUE CROSS BLUE SHIELD
P00030526Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MT0062186Medicaid
1398216OtherARAZ