Provider Demographics
NPI:1902863103
Name:MCCAFFREY, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCCAFFREY
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:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8226
Mailing Address - Fax:
Practice Address - Street 1:4040 HIGHWAY 17 UNIT 301
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5098
Practice Address - Country:US
Practice Address - Phone:843-652-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC186742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5787266001OtherCIGNA
SC5417702OtherHEALTHSOURCE/CIGNA
AL560302OtherAETNA OPEN NETWORK
SC720509OtherMB EVOLUTIONS
SC72855OtherMEDCOST
NCA162OtherNC UHC
PA01839166Medicaid
SC263152OtherONE HEALTH PLAN
SC186747Medicaid
WV1061004OtherWORKERS COMPENSATION
NY3099821OtherGHI
NC850519QMedicaid
SC#10OtherUHC
SC2076382OtherAETNA HMO NETWORK
SC0503969OtherPHYSICIANS HEALTH PLAN
SCF75838Medicare UPIN
SC720510OtherMI EVOLUTIONS
SC130015687Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SC5189F75838Medicare ID - Type UnspecifiedMB MEDICARE