Provider Demographics
NPI:1578539201
Name:MAHONEY, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
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:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-01627207RC0000X, 207RI0011X
VA0101224737207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA275972OtherMAMSI
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VA-001OtherCHAMPUS/TRICARE
VA23759OtherOPTIMA HEALTH PLAN
VAPAROtherCIGNA
VAPAROtherVIRGINIA HEALTH NETWORK
VA257828OtherATHEM BC/BS VA/HK
NC89063G6Medicaid
VA005836336Medicaid
NC89063VCMedicaid
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC063VCOtherBC/BS NC
VA15792OtherSENTARA OHP/SHP
VA005849811Medicaid
VA118777OtherANTHEM BC/BS AND HKPRS
VA375972OtherUHC/MAMSI/MDIPA
VAPAROtherCORVEL/CORCARE
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC89063G6Medicaid
NC063VCOtherBC/BS NC
VA15792OtherSENTARA OHP/SHP
VA23759OtherOPTIMA HEALTH PLAN