Healthcare Provider Details

I. General information

NPI: 1093923492
Provider Name (Legal Business Name): DANIEL HACKETT MCCARTY-PREFONTAINE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DEKALB ST
NORRISTOWN PA
19401-3405
US

IV. Provider business mailing address

1412 FAIRMOUNT AVE
PHILADELPHIA PA
19130-2908
US

V. Phone/Fax

Practice location:
  • Phone: 610-278-7787
  • Fax: 610-278-7386
Mailing address:
  • Phone: 215-599-4851
  • Fax: 215-232-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA001756L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: