Provider Demographics
NPI:1346242799
Name:MCCARTHY, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:MCCARTHY
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 1:310 N 7 HILLS RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4111
Mailing Address - Country:US
Mailing Address - Phone:618-624-6181
Mailing Address - Fax:618-624-8314
Practice Address - Street 1:310 N 7 HILLS RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-4111
Practice Address - Country:US
Practice Address - Phone:618-624-6181
Practice Address - Fax:618-624-8314
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG70012Medicare UPIN