Basic Information
| Provider Information | |||||||||
| NPI: | 1235182692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | NOLA | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1122 STREET RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189664218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159493100 | ||||||||
| FaxNumber: | 2153556304 | ||||||||
| Practice Location | |||||||||
| Address1: | 3840 QUAKERBRIDGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086191003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098902222 | ||||||||
| FaxNumber: | 6098900715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MB50026 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 208VP0000X | MB50026 | NJ | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207QA0401X | OS005339L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.