Healthcare Provider Details

I. General information

NPI: 1235155086
Provider Name (Legal Business Name): JOHN HOWARD MCCABE P.A-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD SUITE 400
PIKESVILLE MD
21208-6391
US

IV. Provider business mailing address

5622 PILGRIM RD
BALTIMORE MD
21214-1526
US

V. Phone/Fax

Practice location:
  • Phone: 410-602-7782
  • Fax: 410-602-2438
Mailing address:
  • Phone: 410-444-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0000137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: