Healthcare Provider Details

I. General information

NPI: 1932105715
Provider Name (Legal Business Name): STUART A MCCARTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SAN BERNARDINO RD STE J
UPLAND CA
91786-4980
US

IV. Provider business mailing address

1330 SAN BERNARDINO RD STE J
UPLAND CA
91786-4980
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-5406
  • Fax: 909-981-4933
Mailing address:
  • Phone: 909-981-5406
  • Fax: 909-981-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG37891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: