Provider Demographics
NPI:1922184035
Name:MCCARTHY, TERESA C (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:C
Last Name:MCCARTHY
Suffix:
Gender:F
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:SMILEY'S CLINIC, 2615 EAST FRANKLIN AVE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:SMILEY'S CLINIC, 2615 EAST FRANKLIN AVE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32692207Q00000X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-02572OtherMEDICA CHOICE
1017485OtherPREFERRED ONE
IA1543785Medicaid
766124OtherARAZ
41G08MCOtherBLUE CROSS BLUE SHIELD
HP21054OtherHEALTH PARTNERS
04-02572OtherMEDICA PRIMARY
MN091797400Medicaid
101484OtherUCARE
04-02572OtherMEDICA CHOICE
D98266Medicare UPIN