1750473013 NPI number — DR. JANET SUSAN MCCARTHY MCAULIFFE MD

Table of content: DR. JANET SUSAN MCCARTHY MCAULIFFE MD (NPI 1750473013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750473013 NPI number — DR. JANET SUSAN MCCARTHY MCAULIFFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCAULIFFE
Provider First Name:
JANET
Provider Middle Name:
SUSAN MCCARTHY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARTHY
Provider Other First Name:
JANET
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750473013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W305N2593 RAVINE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53072-4734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-367-0274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W305N2593 RAVINE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53072-4734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-367-0274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

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: 208000000X , with the licence number:  32213 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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