D Michael Mahan MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25053 Issued in NC

Legal business name

D MICHAEL MAHAN MD PA

Practice address

120 Charles D Rollins Rd
Suite 105
Henderson, NC 27536-2882

Phone

(252) 436-6543

Fax

(252) 436-2109

NPI assigned

Jul 8, 2005

Last updated

Jun 25, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dennis Michael Mahan, M.D.

Title

Ceo

Phone

(919) 693-7108

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Edward Stock, M.D.

  • General Practice Physician
  • Oxford, NC
  • NPI 1952404170

  Family Medicine

  NPD (past)
• Meredith Lea Kehrer, MD

  • Family Medicine Physician
  • Shelbyville, KY
  • NPI 1811992969
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1427056027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CHARLES D ROLLINS RD",
            "address_2": "SUITE 105",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362882",
            "telephone_number": "252-436-6543",
            "fax_number": "252-436-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CHARLES D ROLLINS RD",
            "address_2": "SUITE 105",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362882",
            "telephone_number": "252-436-6543",
            "fax_number": "252-436-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D MICHAEL MAHAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-693-7108",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "25053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012JG",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "012JG",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Creative Foundation, LLC
• Creative Foundations
• Crescent Moon Counseling, Inc.
• John Culp, CRNA
• Gary Cyran, RPH
• Becky Lynn D'Agostino, FNP-BC
• D&D Care Services
• D&D Care Services
• Da Relay Group Inc
• Beulah Margaret Gracelyn Daniel Nirmal Singh

• Family Medicine Physician in Henderson, NC
• Providers in Henderson, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.