MEDICARE: BRIAN MCCARTHY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0102204227	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39020000X	OTHER		TYPE I NPI

General Provider Information

NPI Number	:	1053653899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MCCARTHY D.O.

Provider Business Mailing Address
First Line	:	PO BOX 746871
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6206 N MILITARY HWY STE H
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23518-5447
Country	:	US
Telephone Number	:	757-271-5282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/10/2025

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