Provider Demographics
NPI:1225761257
Name:MCCARTHY, BRANDON MATTHEW (PR)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MATTHEW
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7115
Mailing Address - Country:US
Mailing Address - Phone:304-308-7036
Mailing Address - Fax:
Practice Address - Street 1:301 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8804
Practice Address - Country:US
Practice Address - Phone:304-290-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist