Provider Demographics
NPI:1962485185
Name:MCCARTHY, PAUL L (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
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 1:15 YORK ST
Mailing Address - Street 2:DCB - 14A, DEPT. OF PEDIATRICS
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3221
Mailing Address - Country:US
Mailing Address - Phone:203-688-2470
Mailing Address - Fax:203-688-7274
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:DCB - 14A, DEPT. OF PEDIATRICS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-688-2470
Practice Address - Fax:203-688-7274
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT016924208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001169242Medicaid
CT370000335Medicare ID - Type Unspecified
E48021Medicare UPIN