Provider Demographics
NPI:1528163110
Name:MCCARTHY, GERALD J (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-238-1458
Mailing Address - Fax:
Practice Address - Street 1:3123 SHORE DRIVE
Practice Address - Street 2:STE. 102
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-2299
Practice Address - Fax:715-732-2419
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22221-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI22221-020OtherMEDICAL LICENSE
WI22221-020OtherMEDICAL LICENSE
B54951Medicare UPIN
AM8669559OtherDEA