Provider Demographics
NPI:1265493019
Name:MCCARREN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCCARREN
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 1:2600 SIXTH ST SW
Mailing Address - Street 2:OHIO HOSPITAL BASED PHYSICIANS CORP
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710
Mailing Address - Country:US
Mailing Address - Phone:330-363-7462
Mailing Address - Fax:330-363-7679
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:OHIO HOSPITAL BASED PHYSICIANS CORP
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-7462
Practice Address - Fax:330-363-7679
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064277207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165002Medicaid
OHMC0786725Medicare ID - Type Unspecified
OH0165002Medicaid