1588827638 NPI number — MEGAN MARY MCCARTHY MSN, NP-C, CVNP-BC

Table of content: MEGAN MARY MCCARTHY MSN, NP-C, CVNP-BC (NPI 1588827638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588827638 NPI number — MEGAN MARY MCCARTHY MSN, NP-C, CVNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
MEGAN
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, NP-C, CVNP-BC
Provider Gender Code:
F

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:
1588827638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4192 E PALM BEACH DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-432-1305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2149 E BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-345-0034
Provider Business Practice Location Address Fax Number:
480-345-4033
Provider Enumeration Date:
07/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  TAP3059 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 380892 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".