MEDICARE: MCCULLOUGH MEDICAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	ME107055	FL

General Provider Information

NPI Number	:	1942641675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCULLOUGH MEDICAL PA

Provider Business Mailing Address
First Line	:	1814 WELLNESS LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5357
Country	:	US
Telephone Number	:	727-645-4541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 WELLNESS LN
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-5357
Country	:	US
Telephone Number	:	727-645-4541
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONA MCCULLOUGH
Credential	:	M.D.
Telephone Number	:	727-645-4541

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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