Provider Demographics
NPI:1730286246
Name:MCMAHON MEDICINE LLC
Entity Type:Organization
Organization Name:MCMAHON MEDICINE LLC
Other - Org Name:MCMAHON MEDICINE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-428-9446
Mailing Address - Street 1:1305 N KINGS HIGHWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-428-9446
Mailing Address - Fax:856-428-4330
Practice Address - Street 1:1305 N KINGS HIGHWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-428-9446
Practice Address - Fax:856-428-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07350500207R00000X
NJ25MA02486400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9076409Medicaid
NJ085743Medicare UPIN
NJ069705THBMedicare PIN
NJ085743Medicare PIN
NJ9076409Medicaid
NJ069705THBMedicare PIN
NJ085743Medicare UPIN
NJ2159708Medicaid