Healthcare Provider Details

I. General information

NPI: 1851892400
Provider Name (Legal Business Name): PATRICK MICHAEL MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX 800719
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST BOX 800719
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2150
  • Fax:
Mailing address:
  • Phone: 434-924-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01084205A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01084205A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116038928
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: