Provider Demographics
NPI:1528032695
Name:MCMAHON, KEVIN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OLEAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2540
Mailing Address - Country:US
Mailing Address - Phone:716-805-1072
Mailing Address - Fax:716-805-1073
Practice Address - Street 1:112 OLEAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2540
Practice Address - Country:US
Practice Address - Phone:716-805-1072
Practice Address - Fax:716-805-1073
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01816673Medicaid
NY148853BFOtherPREFERRED CARE
NY0108198OtherIHA
NY040426002690OtherFIDELIS
NY203121OtherLICENSE
NY000524278003OtherBC/BS
NY080192394OtherRAILROAD MEDICARE
NY00010198703OtherUNIVERA
NYCK7008OtherRAILROAD MEDICARE
NY148853BFOtherPREFERRED CARE
NYCK7008OtherRAILROAD MEDICARE
NY01816673Medicaid