Healthcare Provider Details

I. General information

NPI: 1275574501
Provider Name (Legal Business Name): JOHN J MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CAPITOL AVENUE
SACRAMENTO CA
95816
US

IV. Provider business mailing address

310 HARRIS AVENUE SUITE A
SACRAMENTO CA
95838
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-4985
  • Fax: 916-442-1029
Mailing address:
  • Phone: 916-649-6793
  • Fax: 916-929-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG20335
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberDEAAM6705593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: