Provider Demographics
NPI:1194893818
Name:THOMAS K MCMAHAN MD PA
Entity type:Organization
Organization Name:THOMAS K MCMAHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-667-2634
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:1710 PARKWOOD DRIVE NORTH SUITE
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697
Mailing Address - Country:US
Mailing Address - Phone:336-667-2634
Mailing Address - Fax:336-667-6435
Practice Address - Street 1:1710 PARKWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697
Practice Address - Country:US
Practice Address - Phone:336-667-2634
Practice Address - Fax:336-667-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18805207R00000X
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8957769Medicaid
C80701Medicare UPIN
NC8957769Medicaid