Provider Demographics
NPI:1114265436
Name:MCCALL, ISABELLA FAIREY (MD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:FAIREY
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BAMPFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2575
Mailing Address - Country:US
Mailing Address - Phone:843-442-1914
Mailing Address - Fax:
Practice Address - Street 1:307 BAMPFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2575
Practice Address - Country:US
Practice Address - Phone:843-442-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics