Provider Demographics
NPI:1215093331
Name:MARTIN MCMAHON, KAREN MARIE (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARIE
Last Name:MARTIN MCMAHON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:176 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4326
Mailing Address - Country:US
Mailing Address - Phone:716-433-0611
Mailing Address - Fax:716-439-8049
Practice Address - Street 1:670 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5338
Practice Address - Country:US
Practice Address - Phone:716-433-0611
Practice Address - Fax:716-439-8049
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001401-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030008801OtherUNIVERA HEALTHCARE
NY000576056006OtherB.CROSS & B.SHIELD OF WNY
NY000580058003OtherB.CROSS & B.SHIELD OF WNY
NY000576056007OtherB.CROSS & B.SHIELD OF WNY
NY9209408OtherINDEPENDENT HEALTH
NY000580058002OtherB.CROSS & B.SHIELD OF WNY
NY000576056008OtherB.CROSS & B.SHIELD OF WNY
NY000580058005OtherB.CROSS & B.SHIELD OF WNY
NY000580058002OtherB.CROSS & B.SHIELD OF WNY