1245392976 NPI number — MICHELE MCCARTHY PT

Table of content: MICHELE MCCARTHY PT (NPI 1245392976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245392976 NPI number — MICHELE MCCARTHY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1245392976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 PLUMTREE RD
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21015-6044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-569-8587
Provider Business Mailing Address Fax Number:
410-569-3551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 PULASKI HWY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21040-1398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-372-5300
Provider Business Practice Location Address Fax Number:
443-372-5810
Provider Enumeration Date:
12/16/2006

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: 225100000X , with the licence number:  20950 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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