Healthcare Provider Details

I. General information

NPI: 1265993935
Provider Name (Legal Business Name): VICTORIA GORDON MCCARTHY DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MARYLAND RD STE 20
WILLOW GROVE PA
19090-1732
US

IV. Provider business mailing address

2400 MARYLAND RD STE 20
WILLOW GROVE PA
19090-1732
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS025086
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: