Healthcare Provider Details

I. General information

NPI: 1033243316
Provider Name (Legal Business Name): NANA GIRGIS MCMAHON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 OLD ROAD TO 9 ACRE COR SUITE 470
CONCORD MA
01742-4181
US

IV. Provider business mailing address

131 OLD ROAD TO 9 ACRE COR SUITE 470
CONCORD MA
01742-4181
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-5050
  • Fax: 978-371-7292
Mailing address:
  • Phone: 978-369-5050
  • Fax: 978-371-7292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number47202
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NANA GIRGIS MCMAHON
Title or Position: OWNER
Credential: MD
Phone: 978-369-5050