Provider Demographics
NPI:1336146265
Name:MCMAHON, KELLY PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:PATRICE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 CORPORATE DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5861
Mailing Address - Country:US
Mailing Address - Phone:412-358-9613
Mailing Address - Fax:412-358-9619
Practice Address - Street 1:5700 CORPORATE DR
Practice Address - Street 2:SUITE 410
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5861
Practice Address - Country:US
Practice Address - Phone:412-358-9613
Practice Address - Fax:412-358-9619
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071914L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018192430003Medicaid
PA912672OtherHIGHMARK BCBS
PA205884OtherHEALTH AMERICA
PA200076838OtherUPMC
OH2528376Medicaid
OH2528376Medicaid
PAH25270Medicare UPIN