Provider Demographics
NPI:1336161124
Name:MCCARTHY, BRYAN S (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:S
Last Name:MCCARTHY
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:PO BOX 826515
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6515
Mailing Address - Country:US
Mailing Address - Phone:888-733-7271
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:302-744-6407
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0003557207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00615630OtherRAILROAD MEDICARE
DE143118Medicare PIN
DE000J33A97Medicare PIN
DEG02646B03Medicare PIN