Provider Demographics
NPI:1871911230
Name:MAHAN, JENNIFER B (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:MAHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7130 GLEN FOREST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-662-6138
Mailing Address - Fax:804-559-2046
Practice Address - Street 1:8364 BELL CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-559-2046
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15300207V00000X
390200000X
VA0102208270207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty