1235273285 NPI number — GREGORY E MCCARTHY MD.

Table of content: GREGORY E MCCARTHY MD. (NPI 1235273285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235273285 NPI number — GREGORY E MCCARTHY MD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
GREGORY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD.
Provider Gender Code:
M

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:
1235273285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9671
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32120-9671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-676-7130
Provider Business Mailing Address Fax Number:
386-676-7125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2777 ENTERPRISE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-774-2550
Provider Business Practice Location Address Fax Number:
386-775-0176
Provider Enumeration Date:
02/16/2007

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: 207R00000X , with the licence number:  ME121306 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014527100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235273285 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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