Healthcare Provider Details

I. General information

NPI: 1821329327
Provider Name (Legal Business Name): ROBERT EMMETT MCCARTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BARTMAN RD
HIGGANUM CT
06441-4415
US

IV. Provider business mailing address

50 BARTMAN RD
HIGGANUM CT
06441-4415
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-8781
  • Fax: 860-345-2593
Mailing address:
  • Phone: 860-345-8781
  • Fax: 860-345-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number13965
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number13965
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: