Provider Demographics
NPI:1114284635
Name:MCCANN, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SOHN WAY
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9390
Mailing Address - Country:US
Mailing Address - Phone:856-889-9252
Mailing Address - Fax:
Practice Address - Street 1:8 SOHN WAY
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-9390
Practice Address - Country:US
Practice Address - Phone:856-889-9252
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0550492085R0202X
NJ25MA100331002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty