Provider Demographics
NPI:1932174554
Name:MCCAHON, DEBORAH R (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:R
Last Name:MCCAHON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:RUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2295 N SUSQUEHANNA TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-8495
Mailing Address - Country:US
Mailing Address - Phone:717-812-0731
Mailing Address - Fax:717-812-9848
Practice Address - Street 1:2295 N SUSQUEHANNA TRL
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-8495
Practice Address - Country:US
Practice Address - Phone:717-812-0731
Practice Address - Fax:717-812-9848
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009469L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039846OtherGROUP PTAN
PA00178747Medicaid
PAH14561Medicare UPIN
PA039846OtherGROUP PTAN
PAP00043883Medicare PIN