Provider Demographics
NPI:1528382041
Name:STEFANIE J. MCCANN MD PA
Entity Type:Organization
Organization Name:STEFANIE J. MCCANN MD PA
Other - Org Name:STEFANIE J. MCCANN MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-312-9292
Mailing Address - Street 1:18800 PRESTON RD STE 314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8565
Mailing Address - Country:US
Mailing Address - Phone:972-312-9292
Mailing Address - Fax:972-312-9995
Practice Address - Street 1:18800 PRESTON RD STE 314
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-8565
Practice Address - Country:US
Practice Address - Phone:972-312-9292
Practice Address - Fax:972-312-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX48CUOtherBCBS
TXF24407Medicare UPIN
TX00642DMedicare PIN