Provider Demographics
NPI:1356686224
Name:MCMAHON, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2709
Mailing Address - Country:US
Mailing Address - Phone:607-756-8915
Mailing Address - Fax:607-756-1820
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2709
Practice Address - Country:US
Practice Address - Phone:607-756-8915
Practice Address - Fax:607-756-1820
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000031536237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist