Provider Demographics
NPI:1487695557
Name:MCCULLOUGH, JOCK N (MD)
Entity type:Individual
Prefix:DR
First Name:JOCK
Middle Name:N
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - CARDIAC SURGERY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-7390
Mailing Address - Fax:603-650-6346
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC - CARDIAC SURGERY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-7390
Practice Address - Fax:603-650-6346
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05269200208G00000X
NH16767208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037865Medicare ID - Type Unspecified
J36803Medicare UPIN