Provider Demographics
NPI:1346385051
Name:MCMAHON, MARCIE LYNNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:LYNNE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:MARCIE
Other - Middle Name:LYNNE
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 BLANDFORD LN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3108
Mailing Address - Country:US
Mailing Address - Phone:585-899-0977
Mailing Address - Fax:
Practice Address - Street 1:224 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4000
Practice Address - Country:US
Practice Address - Phone:585-922-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402159-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health