Healthcare Provider Details

I. General information

NPI: 1275411852
Provider Name (Legal Business Name): KIERA MCCARTHY AT/S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 HALE ST
BEVERLY MA
01915-2096
US

IV. Provider business mailing address

40 FOX DEN RD
DANBURY CT
06811-3424
US

V. Phone/Fax

Practice location:
  • Phone: 203-297-5868
  • Fax:
Mailing address:
  • Phone: 203-297-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number---
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: