MEDICARE: MICHAEL J MCCARTHY MD

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	2084P0800X	Psychiatry Physician	MD019518E	PA

General Provider Information

NPI Number	:	1639151863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J MCCARTHY MD

Provider Business Mailing Address
First Line	:	2978 N PROVIDENCE RD
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-4317
Country	:	US
Telephone Number	:	610-565-8714
Fax Number	:	610-565-8714

Provider Business Practice Location Address
First Line	:	2400 CHESTNUT ST
Second Line	:	STE 1409
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4316
Country	:	US
Telephone Number	:	215-567-4773
Fax Number	:	215-567-4723

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	10/23/2018

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