Provider Demographics
NPI:1063594810
Name:MCMAHON, JOHN G JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:MCMAHON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 WOODLAKE VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2200
Mailing Address - Country:US
Mailing Address - Phone:804-739-6730
Mailing Address - Fax:804-739-6894
Practice Address - Street 1:6512 WOODLAKE VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2200
Practice Address - Country:US
Practice Address - Phone:804-739-6730
Practice Address - Fax:804-739-6894
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300915213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5293010001OtherMEDICARE DME PROVIDER
VA010091144Medicaid
VA010091144Medicaid
VA010091144Medicaid
VA00W137A01Medicare PIN