Provider Demographics
NPI:1275948085
Name:MCCARTHY, PATRICK KEVIN (RD LD CLC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KEVIN
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:RD LD CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 EAST CHEVES STREET
Mailing Address - Street 2:FLORENCE COUNTY HEALTH DEPT.
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506
Mailing Address - Country:US
Mailing Address - Phone:843-673-6634
Mailing Address - Fax:
Practice Address - Street 1:145 EAST CHEVES STREET
Practice Address - Street 2:FLORENCE COUNTY HEALTH DEPT.
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506
Practice Address - Country:US
Practice Address - Phone:843-673-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered