Provider Demographics
NPI:1003867086
Name:MCMAHON, CALLIE ORAE (PAC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ORAE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ORAE
Other - Last Name:SIGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 MAINE ST. BOX 44
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-373-1572
Mailing Address - Fax:
Practice Address - Street 1:123 MEDICAL CENTER TR.
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-725-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003192363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q79298Medicare UPIN