Provider Demographics
NPI:1881636256
Name:MACCARTHY, JUSTIN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:MACCARTHY
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 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-768-2822
Mailing Address - Fax:814-768-2821
Practice Address - Street 1:807 TURNPIKE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1238
Practice Address - Country:US
Practice Address - Phone:814-768-2822
Practice Address - Fax:814-768-2821
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400908174400000X
PAMD430012207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001888778OtherHIGHMARK PIN
PA1017462840001Medicaid
PA1017462840001Medicaid
PA001888778OtherHIGHMARK PIN