Provider Demographics
NPI:1164679502
Name:MACMAHON, JAMES ROSS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROSS
Last Name:MACMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 BURNHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-2868
Mailing Address - Fax:207-822-2694
Practice Address - Street 1:79 SCHOONER ST.
Practice Address - Street 2:MILES MEDICAL GROUP (PEDIATRICS) VANWINKLE MEDICAL BLDG
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME7464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics