Healthcare Provider Details

I. General information

NPI: 1043475940
Provider Name (Legal Business Name): MCCARTY ANESTHESIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 05/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SOLSTICE WAY
SHARON MA
02067-3140
US

IV. Provider business mailing address

4 SOLSTICE WAY
SHARON MA
02067-3140
US

V. Phone/Fax

Practice location:
  • Phone: 617-913-3363
  • Fax: 617-945-2314
Mailing address:
  • Phone: 617-913-3363
  • Fax: 617-945-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDN2191520A
License Number StateMA

VIII. Authorized Official

Name: CAROLINE Y CHUN
Title or Position: OFFICE MANAGER
Credential:
Phone: 617-913-3363