Provider Demographics
NPI:1609187681
Name:MCCARTHY, CAITLIN K (MD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:K
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:K
Other - Last Name:GADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1810 E 19TH ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3388
Mailing Address - Country:US
Mailing Address - Phone:541-296-6101
Mailing Address - Fax:541-296-0025
Practice Address - Street 1:1810 E 19TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3388
Practice Address - Country:US
Practice Address - Phone:541-296-6101
Practice Address - Fax:541-296-0025
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170815208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500693766Medicaid
OR500693766Medicaid