Provider Demographics
NPI:1770700528
Name:MCMAHON, KERRY MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:MAUREEN
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 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-426-6878
Mailing Address - Fax:253-426-4254
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-426-6878
Practice Address - Fax:253-426-4254
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048042207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0266435OtherL&I
WA0266443OtherL&I
WA8476772Medicaid
WA8864935Medicare ID - Type UnspecifiedUW PHYSICIANS
WA0266443OtherL&I
WA8476772Medicaid
WAG8911438Medicare PIN