Provider Demographics
NPI:1902803976
Name:MCCARTHY, EDWARD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MICHAEL
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 VAN WINKLE DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-358-1497
Mailing Address - Fax:806-358-1375
Practice Address - Street 1:4512 VAN WINKLE DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-358-1497
Practice Address - Fax:806-358-1375
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5831207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157344601Medicaid
TX157343801Medicaid
P00005113OtherRAILROAD MEDICARE NUMBER
00909UMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TX157343801Medicaid
TX157344601Medicaid