Provider Demographics
NPI:1841671914
Name:MCKAY, JOHN THOMAS (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MCKAY
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:WAKE FOREST BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4464
Mailing Address - Fax:336-716-5687
Practice Address - Street 1:WAKE FOREST BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4464
Practice Address - Fax:336-716-5687
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01494207RH0003X
IN11018433A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program