1033243316 NPI number — NANA GIRGIS MCMAHON, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033243316 NPI number — NANA GIRGIS MCMAHON, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANA GIRGIS MCMAHON, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033243316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 OLD ROAD TO 9 ACRE COR
Provider Second Line Business Mailing Address:
SUITE 470
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-369-5050
Provider Business Mailing Address Fax Number:
978-371-7292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 OLD ROAD TO 9 ACRE COR
Provider Second Line Business Practice Location Address:
SUITE 470
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-5050
Provider Business Practice Location Address Fax Number:
978-371-7292
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCMAHON
Authorized Official First Name:
NANA
Authorized Official Middle Name:
GIRGIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-369-5050

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  47202 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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