Healthcare Provider Details

I. General information

NPI: 1538121595
Provider Name (Legal Business Name): DENIS MATTHEW MCCARTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMVAHCS-111F 1501 SAN PEDRO BLVD. SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

3012 DON QUIXOTE DR NW
ALBUQUERQUE NM
87104-3036
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-2801
  • Fax: 505-256-5751
Mailing address:
  • Phone: 505-247-3248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberNM-203
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: