Provider Demographics
NPI:1952309742
Name:MCMAHON, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
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 1:1305 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1919
Mailing Address - Country:US
Mailing Address - Phone:856-428-9446
Mailing Address - Fax:856-428-4330
Practice Address - Street 1:1305 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1919
Practice Address - Country:US
Practice Address - Phone:856-428-9446
Practice Address - Fax:856-428-4330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02486400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K1610OtherHEALTHNET
NJ3451009OtherAETNA
NJ0080547001OtherAMERIHEALTH
NJ2159708Medicaid
NJ0896468OtherCIGNA
NJ113641THBMedicare ID - Type Unspecified
NJ2159708Medicaid