Healthcare Provider Details

I. General information

NPI: 1962468959
Provider Name (Legal Business Name): ELLEN M MCMAHON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/03/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PIKES HL
NORWAY ME
04268-5340
US

IV. Provider business mailing address

8 PIKES HL
NORWAY ME
04268-5340
US

V. Phone/Fax

Practice location:
  • Phone: 207-744-6444
  • Fax:
Mailing address:
  • Phone: 207-744-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number214075
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number214075
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24876
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: