Provider Demographics
NPI:1235339771
Name:MCCARDELL, JAY PAUL IV (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:PAUL
Last Name:MCCARDELL
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:409 SOUTH SECOND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7694
Practice Address - Country:US
Practice Address - Phone:717-782-3282
Practice Address - Fax:717-231-8964
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014136207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102377720Medicaid
PA234405HF5Medicare PIN