Healthcare Provider Details

I. General information

NPI: 1699831149
Provider Name (Legal Business Name): VINCENT P MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 MIDDLE CREEK RD STE 212
SEVIERVILLE TN
37862-5019
US

IV. Provider business mailing address

742 MIDDLE CREEK RD STE 212
SEVIERVILLE TN
37862-5019
US

V. Phone/Fax

Practice location:
  • Phone: 865-446-7625
  • Fax: 865-446-4626
Mailing address:
  • Phone: 865-446-7625
  • Fax: 865-446-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36642
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number36642
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number36642
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number36642
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number18483
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: