Provider Demographics
NPI:1962419457
Name:MCCARTHY, DIANA (C PED)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5968
Mailing Address - Country:US
Mailing Address - Phone:920-235-3470
Mailing Address - Fax:920-235-3497
Practice Address - Street 1:714 OREGON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5968
Practice Address - Country:US
Practice Address - Phone:920-235-3470
Practice Address - Fax:920-235-3497
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1051490001Medicare NSC