Provider Demographics
NPI:1528423506
Name:H. RELTON MCCARROLL JR. MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:H. RELTON MCCARROLL JR. MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H. RELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARROLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:415-392-3225
Mailing Address - Street 1:2351 CLAY ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1931
Mailing Address - Country:US
Mailing Address - Phone:415-392-3225
Mailing Address - Fax:
Practice Address - Street 1:2351 CLAY ST STE 510
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-392-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27305207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43312Medicare UPIN