Provider Demographics
NPI:1609118918
Name:MCCARTHY, COLIN J (MB BCH BAO)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 LONGWOOD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5395
Mailing Address - Country:US
Mailing Address - Phone:617-632-7441
Mailing Address - Fax:
Practice Address - Street 1:375 LONGWOOD AVE STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5395
Practice Address - Country:US
Practice Address - Phone:617-632-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2690662085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology