MEDICARE: DR. BRIAN R MCMAHON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	168902	NY

General Provider Information

NPI Number	:	1457325607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN R MCMAHON M.D.

Provider Business Mailing Address
First Line	:	79 RICE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2509
Country	:	US
Telephone Number	:	718-390-0400
Fax Number	:	718-390-0566

Provider Business Practice Location Address
First Line	:	125 SLOSSON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2517
Country	:	US
Telephone Number	:	719-390-0400
Fax Number	:	718-390-0566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	10/29/2010

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