Provider Demographics
NPI:1679622690
Name:MCMAHON, ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4396
Mailing Address - Country:US
Mailing Address - Phone:206-215-2090
Mailing Address - Fax:206-215-3099
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4396
Practice Address - Country:US
Practice Address - Phone:206-215-2090
Practice Address - Fax:206-215-3099
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00543208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2299716AMedicare ID - Type Unspecified
NC891311PMedicare ID - Type Unspecified
H57184Medicare ID - Type Unspecified