Provider Demographics
NPI:1871790097
Name:DICKENS, MAHLON ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MAHLON
Middle Name:ALAN
Last Name:DICKENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2709 BLUE RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:919-782-5400
Mailing Address - Fax:919-782-1680
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-782-5400
Practice Address - Fax:919-782-1680
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-06-16
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Provider Licenses
StateLicense IDTaxonomies
NC9500885207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG05223Medicare UPIN