Basic Information
| Provider Information | |||||||||
| NPI: | 1578539201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 KEMPSVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 KEMPSVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7572610701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
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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 | 207RC0000X | 0101224737 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 0101224737 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 23759 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 375972 | 01 | VA | UHC/MAMSI/MDIPA | OTHER | 005836336 | 05 | VA | MEDICAID | 89063VC | 05 | NC | MEDICAID | PAR | 01 | VA | CIGNA | OTHER | 005849811 | 05 | VA | MEDICAID | 15792 | 01 | VA | SENTARA OHP/SHP | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 063VC | 01 | NC | BC/BS NC | OTHER | 257828 | 01 | VA | ATHEM BC/BS VA/HK | OTHER | 89063G6 | 05 | NC | MEDICAID | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | -001 | 01 | VA | CHAMPUS/TRICARE | OTHER | 118777 | 01 | VA | ANTHEM BC/BS AND HKPRS | OTHER | 275972 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER |