Provider Demographics
NPI:1588638761
Name:MCCARTHY, KEVIN C (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
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 1:419 HOLIDAY COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-4200
Mailing Address - Fax:540-341-7054
Practice Address - Street 1:419 HOLIDAY COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-4200
Practice Address - Fax:540-341-7054
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010026130Medicaid
VAG11681Medicare UPIN
VA00V669P79Medicare ID - Type Unspecified