Provider Demographics
NPI:1710929633
Name:FLYNN, THERESA MCCARTHY (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MCCARTHY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1808
Mailing Address - Country:US
Mailing Address - Phone:919-414-0655
Mailing Address - Fax:919-212-9325
Practice Address - Street 1:10 SUNNYBROOK RD
Practice Address - Street 2:WCHS CHILD HEALTH CLINIC
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1808
Practice Address - Country:US
Practice Address - Phone:919-250-4570
Practice Address - Fax:919-212-9325
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200687208000000X
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHO6322Medicare UPIN