Provider Demographics
NPI:1184665622
Name:MCCARTHY, JEANE (PHD, MD)
Entity Type:Individual
Prefix:DR
First Name:JEANE
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863298
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3298
Mailing Address - Country:US
Mailing Address - Phone:727-767-4378
Mailing Address - Fax:
Practice Address - Street 1:880 6TH ST S
Practice Address - Street 2:SUITE 470
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4827
Practice Address - Country:US
Practice Address - Phone:727-767-4313
Practice Address - Fax:727-767-4391
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00248672080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52965OtherBC/BS NUMBER
D56351Medicare UPIN