Provider Demographics
NPI:1992793186
Name:MAHONEY, MAURICE J (MD)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:J
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YALE CHILDREN'S HOSPITAL, WEST PAVILION, 2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-2660
Mailing Address - Fax:203-785-3404
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE CHILDREN'S HOSPITAL, WEST PAVILION, 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-2660
Practice Address - Fax:203-785-3404
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013672207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001136720Medicaid
CT110001807Medicare ID - Type Unspecified
CT001136720Medicaid