Healthcare Provider Details

I. General information

NPI: 1770700528
Provider Name (Legal Business Name): KERRY MAUREEN MCMAHON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 202
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 202
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6878
  • Fax: 253-426-4254
Mailing address:
  • Phone: 253-426-6878
  • Fax: 253-426-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD00048042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: