Basic Information
| Provider Information | |||||||||
| NPI: | 1225282585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAN | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024426365 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 LIMESTONE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024426365 | ||||||||
| FaxNumber: | 3026333350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 03/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C5-0000644 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00751423 | 01 | RAILROAD MEDICARE | OTHER |