Provider Demographics
NPI:1669445714
Name:MCCOOL, MATTHEW GERARD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GERARD
Last Name:MCCOOL
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:PO BOX 3024
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0298
Mailing Address - Country:US
Mailing Address - Phone:518-561-1603
Mailing Address - Fax:866-633-6132
Practice Address - Street 1:931 TOPPINO DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4269
Practice Address - Country:US
Practice Address - Phone:305-293-1801
Practice Address - Fax:305-293-1896
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59665207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371010600Medicaid
FL18199AMedicare PIN
FL0471260001Medicare NSC
FL371010600Medicaid