Basic Information
| Provider Information | |||||||||
| NPI: | 1962485185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | DCB - 14A, DEPT. OF PEDIATRICS | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882470 | ||||||||
| FaxNumber: | 2036887274 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 YORK ST | ||||||||
| Address2: | DCB - 14A, DEPT. OF PEDIATRICS | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882470 | ||||||||
| FaxNumber: | 2036887274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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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 | 208000000X | 016924 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0216X | 016924 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 001169242 | 05 | CT | MEDICAID |