Provider Demographics
NPI:1790800357
Name:MCCARTY, TIMOTHY MICHAEL (C-PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:C-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450B WASHINGTON JACKSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7601
Mailing Address - Country:US
Mailing Address - Phone:937-456-8340
Mailing Address - Fax:937-456-8341
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 104
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8340
Practice Address - Fax:937-456-8341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical