Individual provider Active NPI

Deborah Anne McMahan, MD

  • Internal Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1366563165
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01041980 Issued in IN
Practice address
4813 New Haven Ave
Fort Wayne, IN 46803-3018
Phone
(260) 449-7670
Fax
(260) 427-1391
NPI assigned
Apr 2, 2007
Last updated
Jan 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01041980 IN Primary

Addresses

Primary practice location

4813 New Haven Ave
Fort Wayne, IN 46803-3018

Mailing address

200 E Berry St
Suite 360
Fort Wayne, IN 46802-2731
Phone (260) 449-7670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01041980INMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1366563165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E BERRY ST",
            "address_2": "SUITE 360",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468022731",
            "telephone_number": "260-449-7670",
            "fax_number": "260-427-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4813 NEW HAVEN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468033018",
            "telephone_number": "260-449-7670",
            "fax_number": "260-427-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHAN",
        "first_name": "DEBORAH",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01041980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.