MEDICARE: O' DELL MCCANTS 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	207V00000X	Obstetrics & Gynecology Physician	0101022991	VA

General Provider Information

NPI Number	:	1801987391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	O' DELL MCCANTS MD

Provider Business Mailing Address
First Line	:	4717 MARSHALL AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23607-2225
Country	:	US
Telephone Number	:	757-380-8709
Fax Number	:	757-928-0902

Provider Business Practice Location Address
First Line	:	4717 MARSHALL AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23607-2225
Country	:	US
Telephone Number	:	757-380-8709
Fax Number	:	757-928-0902

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/24/2007

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