Provider Demographics
NPI:1790746196
Name:MCMAHON, NANA GIRGIS
Entity Type:Individual
Prefix:DR
First Name:NANA
Middle Name:GIRGIS
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ORNAC
Mailing Address - Street 2:SUITE 470
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4181
Mailing Address - Country:US
Mailing Address - Phone:978-369-5050
Mailing Address - Fax:978-371-7292
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:SUITE 470
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-369-5050
Practice Address - Fax:978-371-7292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA472022080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF36447Medicare UPIN