Provider Demographics
NPI:1275537078
Name:MCCARTY, EMMA EK (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:EK
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:EK
Other - Last Name:FORTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3573
Mailing Address - Country:US
Mailing Address - Phone:303-440-3122
Mailing Address - Fax:303-440-3282
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-440-3122
Practice Address - Fax:303-440-3282
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13626R207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431290Medicaid
CO414798YLMVOtherMEDICARE PTAN
CO87150018Medicaid
CO414798YLMVOtherMEDICARE PTAN
LAH20133Medicare UPIN