Healthcare Provider Details

I. General information

NPI: 1235131491
Provider Name (Legal Business Name): STEVEN J MCMAHON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/19/2025
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LAKE BOONE TR SUITE 100
RALEIGH NC
27607
US

IV. Provider business mailing address

4600 LAKE BOONE TR SUITE 100
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-1374
  • Fax: 919-571-8135
Mailing address:
  • Phone: 919-787-1374
  • Fax: 919-571-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number200700554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: