Provider Demographics
NPI:1801938097
Name:MCMAHON, JEAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
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 1:296 MIDDLELINE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3315
Mailing Address - Country:US
Mailing Address - Phone:518-885-3780
Mailing Address - Fax:
Practice Address - Street 1:1873 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-690-4420
Practice Address - Fax:518-690-4427
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00934969Medicaid
NY00934969Medicaid
C59443Medicare UPIN