Healthcare Provider Details

I. General information

NPI: 1487850780
Provider Name (Legal Business Name): PATRICK JOSEPH MCCANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2007
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GATEWAY CORPORATE BLVD STE 130
COLUMBIA SC
29203-8918
US

IV. Provider business mailing address

110 GATEWAY CORPORATE BLVD STE 130
COLUMBIA SC
29203-8918
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-4514
  • Fax:
Mailing address:
  • Phone: 803-865-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37187
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2006015651
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2008022576
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number37187
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: