Provider Demographics
NPI:1770605313
Name:MCMAHON, LISA M E (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M E
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:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-1527
Mailing Address - Country:US
Mailing Address - Phone:340-719-1266
Mailing Address - Fax:340-719-1263
Practice Address - Street 1:3227 ESTATE GOLDEN ROCK
Practice Address - Street 2:SUITE 3 BOX 4
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4330
Practice Address - Country:US
Practice Address - Phone:340-719-1266
Practice Address - Fax:340-719-1263
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0020456Medicare ID - Type Unspecified
VIH28771Medicare UPIN