Provider Demographics
NPI:1265476832
Name:MCCARTHY, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MCCARTHY
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:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:4070 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1556
Practice Address - Country:US
Practice Address - Phone:610-825-5741
Practice Address - Fax:610-825-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050726L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2124112OtherALLIANCE/OPT CHC (MAMSI)
PA36452-MD050726LOtherHEALTH PARTNERS
PA0211178000OtherIBC - PC/KHPE
PA0146806801OtherAMERICHOICE (UHC MA PLAN)
PA080128424OtherRRM
PA4460765OtherAETNA PPO
PA0464662OtherAETNA HMO
PA0211178000OtherAMERIHEALTH/INTERCOUNTY
PA11047275OtherMULTIPLAN
PA1027897OtherKEYSTONE MERCY
PA0014680680002Medicaid
PA10932098OtherCAQH ID#
PA1302007OtherCIGNA HMO/PPO
PA476269OtherHIGHMARK BLUE SHIELD
PA476269HQUMedicare ID - Type UnspecifiedHGSA
PA0014680680002Medicaid