Basic Information
| Provider Information | |||||||||
| NPI: | 1164541637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTNEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048255333 | ||||||||
| FaxNumber: | 7048251751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048255333 | ||||||||
| FaxNumber: | 7048251751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 35.089845 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 2008-01732 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 390200000X | 4301084246 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2008-01732 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 020511 | 05 | AZ | MEDICAID |