Provider Demographics
NPI:1639168735
Name:MCMAHON, CHARLES DEWEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DEWEY
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0280
Mailing Address - Country:US
Mailing Address - Phone:719-440-0058
Mailing Address - Fax:719-434-8855
Practice Address - Street 1:3245 INTERNATIONAL CIR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3152
Practice Address - Country:US
Practice Address - Phone:719-633-8000
Practice Address - Fax:719-434-8855
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0018837207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000142156Medicaid
COD23506Medicare UPIN
COCK9218Medicare PIN
CO18837OtherSTATE LICENSE