Provider Demographics
NPI:1932105715
Name:MCCARTHY, STUART A (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:A
Last Name:MCCARTHY
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 1:1330 SAN BERNARDINO RD
Mailing Address - Street 2:STE J
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4980
Mailing Address - Country:US
Mailing Address - Phone:909-981-5406
Mailing Address - Fax:909-981-4933
Practice Address - Street 1:1330 SAN BERNARDINO RD
Practice Address - Street 2:STE J
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4980
Practice Address - Country:US
Practice Address - Phone:909-981-5406
Practice Address - Fax:909-981-4933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37891207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G378910Medicare ID - Type Unspecified