Provider Demographics
NPI:1295743490
Name:MAHONEY, STEPHEN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
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 1:2925 BRIARPARK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3732
Mailing Address - Country:US
Mailing Address - Phone:281-558-3376
Mailing Address - Fax:281-558-0544
Practice Address - Street 1:2925 BRIARPARK DR STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3720
Practice Address - Country:US
Practice Address - Phone:281-558-3376
Practice Address - Fax:281-558-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF57203Medicare UPIN
TX89470JMedicare ID - Type Unspecified