Provider Demographics
NPI:1538189519
Name:MCMAHON, SANDRA E (MD,)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:MCMAHON
Suffix:
Gender:F
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:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:803-328-0181
Mailing Address - Fax:803-328-0553
Practice Address - Street 1:2450 INDIA HOOK ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3271
Practice Address - Country:US
Practice Address - Phone:803-328-0181
Practice Address - Fax:803-328-0553
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19087207R00000X
NC9700330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190876Medicaid
110146452OtherRR MEDICARE
NC1182VOtherBCBS-NC
NC2075577Medicare PIN
SCC120141909Medicare PIN
C12014Medicare UPIN