Healthcare Provider Details

I. General information

NPI: 1598261232
Provider Name (Legal Business Name): ERIN MCMAHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 REMINGTON AVE STE 2000
BALTIMORE MD
21211-3037
US

IV. Provider business mailing address

1301 ALICEANNA ST APT 1310
BALTIMORE MD
21231-2891
US

V. Phone/Fax

Practice location:
  • Phone: 845-406-1585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0091007
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: