Provider Demographics
NPI:1245334499
Name:MCMAHON, CONNETTE PEARL (MD)
Entity type:Individual
Prefix:MRS
First Name:CONNETTE
Middle Name:PEARL
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1261 OLIVER STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4450
Mailing Address - Country:US
Mailing Address - Phone:910-323-1626
Mailing Address - Fax:910-323-9056
Practice Address - Street 1:1261 OLIVER STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4450
Practice Address - Country:US
Practice Address - Phone:910-323-1626
Practice Address - Fax:910-323-9056
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400237207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137NTMedicaid
NC2073420Medicare ID - Type Unspecified
NC89137NTMedicaid
I26315Medicare UPIN