Healthcare Provider Details

I. General information

NPI: 1629307756
Provider Name (Legal Business Name): CHAD EDWARD MCCARTHY CHAD MCCARTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2009
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

747 52ND STREET
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4800
  • Fax:
Mailing address:
  • Phone: 510-428-3240
  • Fax: 510-601-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122169
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA122169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: