Provider Demographics
NPI:1699831149
Name:MCCARTHY, VINCENT P (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:P
Last Name:MCCARTHY
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 1:742 MIDDLE CREEK RD
Mailing Address - Street 2:STE 212
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5019
Mailing Address - Country:US
Mailing Address - Phone:865-446-7625
Mailing Address - Fax:865-446-4626
Practice Address - Street 1:742 MIDDLE CREEK RD
Practice Address - Street 2:STE 212
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5019
Practice Address - Country:US
Practice Address - Phone:865-446-7625
Practice Address - Fax:865-446-4626
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36642208000000X, 2080P0214X, 2080S0012X, 2083P0011X
TN184832080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6479064500Medicaid
TNQ000414Medicaid
IN200903130Medicaid
KY6479064500Medicaid
TN103IC05628Medicare PIN
TNQ000414Medicaid
TN103IC02690Medicare PIN