Provider Demographics
NPI:1558095059
Name:MCCARTHY, KIERAN PAUL
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:PAUL
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 S KINGSHIGHWAY BLVD APT 12S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1330
Mailing Address - Country:US
Mailing Address - Phone:314-459-2809
Mailing Address - Fax:
Practice Address - Street 1:ST LOUIS UNIVERSITY SCHOOL OF MEDICINE
Practice Address - Street 2:OFFICE OF GRADUATE MEDICAL EDUCATION
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-6310
Practice Address - Country:US
Practice Address - Phone:314-977-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health