Provider Demographics
NPI:1972503332
Name:MCSHEA, JOSEPH B (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:MCSHEA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5945
Practice Address - Street 1:122 OKATIE CENTER BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3782
Practice Address - Country:US
Practice Address - Phone:843-706-8840
Practice Address - Fax:833-314-0430
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600315207Q00000X
SC1304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0031BMedicaid
NC1972503332Medicaid
SCN0031BMedicaid
NC2403069BMedicare PIN
NCNCR850BMedicare PIN
F83116Medicare UPIN
NCNCR850AMedicare PIN
NCNCR850DMedicare PIN
NCNCR850EMedicare PIN