Provider Demographics
NPI:1730162538
Name:MCCANN, KARLA D (DO)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:D
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1003
Mailing Address - Country:US
Mailing Address - Phone:833-906-0106
Mailing Address - Fax:724-763-9235
Practice Address - Street 1:432 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORD CITY
Practice Address - State:PA
Practice Address - Zip Code:16226-1003
Practice Address - Country:US
Practice Address - Phone:833-906-0106
Practice Address - Fax:724-763-9235
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009819L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017359020008Medicaid
PA023849RNOMedicare ID - Type Unspecified
PA0017359020008Medicaid