Provider Demographics
NPI:1598135063
Name:MCCANN, JOSHUA
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCCANN
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 1:386 ROHLFING RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62916-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 ROHLFING RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL HILL
Practice Address - State:IL
Practice Address - Zip Code:62916-2410
Practice Address - Country:US
Practice Address - Phone:314-973-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3522272471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy