Provider Demographics
NPI:1215290747
Name:MCMAHON-ESTEPHAN, MARY PATRICIA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:MCMAHON-ESTEPHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SPLIT RAIL RUN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-9556
Mailing Address - Country:US
Mailing Address - Phone:585-586-8270
Mailing Address - Fax:585-586-8930
Practice Address - Street 1:29 SPLIT RAIL RUN
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-9556
Practice Address - Country:US
Practice Address - Phone:585-586-8270
Practice Address - Fax:585-586-8930
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist