Provider Demographics
NPI:1699773416
Name:MCMAHON, MARY ANN PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:PATRICIA
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2339 ROUTE 70 W STE 200
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3315
Practice Address - Country:US
Practice Address - Phone:856-536-1515
Practice Address - Fax:856-412-5310
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2235465001OtherAMERIHEALTH
NJ2K5921OtherHEALTHNET
NJ5649538OtherCIGNA
NJ869238OtherAETNA
NJ9076409Medicaid
NJ869238OtherAETNA
NJ2235465001OtherAMERIHEALTH