Provider Demographics
NPI:1255385662
Name:MCCARREN, DONALD M (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:MCCARREN
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:19057 AQUA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7894
Mailing Address - Country:US
Mailing Address - Phone:610-420-4488
Mailing Address - Fax:239-237-5574
Practice Address - Street 1:28420 BONITA CROSSINGS BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-3203
Practice Address - Country:US
Practice Address - Phone:239-235-0380
Practice Address - Fax:239-237-5574
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2024-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007198L2084N0400X
DEC2-00048982084N0400X
NJ25MB065427002084N0400X
FLOS156472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102091500Medicaid
NJ0000045419Medicare ID - Type Unspecified
NJF80817Medicare UPIN