Healthcare Provider Details

I. General information

NPI: 1639163322
Provider Name (Legal Business Name): ROBERT W MCCARTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 N LEBANON ST STE 405
LEBANON IN
46052-8621
US

IV. Provider business mailing address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

V. Phone/Fax

Practice location:
  • Phone: 765-485-8444
  • Fax: 765-485-8439
Mailing address:
  • Phone: 765-485-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01047275A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: