Basic Information
| Provider Information | |||||||||
| NPI: | 1407243504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | LIAM | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL DEPT OF | ||||||||
| Address2: | DOWLING 1 SOUTH ROOM 1322 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL DEPT OF | ||||||||
| Address2: | DOWLING 1 SOUTH ROOM 1322 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144929 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2015 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 278720 | MA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | MD17234 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.