Provider Demographics
NPI:1770581464
Name:MCCARTHY, REBECCA A (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 VAN WINKLE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-358-1497
Mailing Address - Fax:806-358-1375
Practice Address - Street 1:4512 VAN WINKLE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-358-1497
Practice Address - Fax:806-358-1375
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7452207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157343801OtherMEDICAID GROUP NUMBER
00909UOtherMEDICARE GROUP NUMBER
TX045009002Medicaid
P00004304OtherRAILROAD MEDICARE NUMBER
00909UOtherMEDICARE GROUP NUMBER
TX157343801OtherMEDICAID GROUP NUMBER