Provider Demographics
NPI:1679551733
Name:TIMOTHY J MCCANN, MD, PC
Entity Type:Organization
Organization Name:TIMOTHY J MCCANN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-647-0554
Mailing Address - Street 1:3338 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2000
Mailing Address - Country:US
Mailing Address - Phone:314-647-0554
Mailing Address - Fax:314-647-8387
Practice Address - Street 1:3338 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2000
Practice Address - Country:US
Practice Address - Phone:314-647-0554
Practice Address - Fax:314-647-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-08
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG7621OtherRAILROAD MEDICARE
MO000013542Medicare ID - Type Unspecified