Provider Demographics
NPI:1588633358
Name:MCCANN, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MCCANN
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 1:801 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4070
Mailing Address - Country:US
Mailing Address - Phone:864-261-8000
Mailing Address - Fax:864-224-1514
Practice Address - Street 1:801 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4070
Practice Address - Country:US
Practice Address - Phone:864-261-8000
Practice Address - Fax:864-224-1514
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC170772Medicaid
SCSC77117043Medicare PIN
SC4585Medicare PIN