Provider Demographics
NPI:1922199264
Name:MCMAHON, MAUREEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:C
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:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:NEMOURS PEDIATRICS LANKENAU
Practice Address - Street 2:100 E. LANCASTER AVE. SUITE 436
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-6333
Practice Address - Fax:610-645-6064
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062455L208000000X, 208D00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2542Medicaid
MD4027523Medicaid
PA1721587Medicaid
G85142Medicare UPIN
022689SAJMedicare PIN