Provider Demographics
NPI:1467403345
Name:MCMAHON, JOAN M (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
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 1:310 WENDELL AVE
Mailing Address - Street 2:ATT: CLINIC MANAGER
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-1502
Mailing Address - Fax:406-535-6299
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:ATT: CLINIC MANAGER
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-6451
Practice Address - Fax:406-535-6299
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9666174400000X
MTMED-PHYS-LIC-9666208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0029206Medicaid
MT810536408OtherTAX ID #
MTH26713Medicare UPIN