Provider Demographics
NPI:1508800012
Name:MCCARTY, EMILY J (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:J
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:805 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-6001
Mailing Address - Country:US
Mailing Address - Phone:937-596-0456
Mailing Address - Fax:937-596-0462
Practice Address - Street 1:805 E PIKE ST
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334-6001
Practice Address - Country:US
Practice Address - Phone:937-596-0456
Practice Address - Fax:937-596-0462
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2994130Medicaid
OH2994130Medicaid
MIBR7977335OtherDEA