Provider Demographics
NPI:1841283579
Name:MCCARTHY, SALLYANN (RN)
Entity type:Individual
Prefix:
First Name:SALLYANN
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:301-698-7385
Mailing Address - Fax:240-379-6050
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 120-B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:301-698-7385
Practice Address - Fax:240-379-6050
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR083371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR083371OtherRN LICENSE
MD2222-0327OtherCERT DIABETES EDUCATOR