Provider Demographics
NPI:1114996709
Name:MCMAHON, PATRICK MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W TILGHMAN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9109
Mailing Address - Country:US
Mailing Address - Phone:610-395-4044
Mailing Address - Fax:
Practice Address - Street 1:5000 W TILGHMAN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9109
Practice Address - Country:US
Practice Address - Phone:610-395-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN353111L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS38490Medicare UPIN
PA069468Medicare ID - Type Unspecified