Provider Demographics
NPI:1396816617
Name:THOMAS P. MCMAHON, MD, INC.
Entity Type:Organization
Organization Name:THOMAS P. MCMAHON, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-293-5600
Mailing Address - Street 1:110 CLOCK TOWER SQ
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1396
Mailing Address - Country:US
Mailing Address - Phone:401-293-5600
Mailing Address - Fax:401-293-5604
Practice Address - Street 1:110 CLOCK TOWER SQ
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1396
Practice Address - Country:US
Practice Address - Phone:401-293-5600
Practice Address - Fax:401-293-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6825207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI109006075Medicare PIN