Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101271135 | VA |
NPI | 1043605975 |
---|---|
Provider Name | Dr. Michael Gerard Mccusker JR. |
First Address | Winchester, VA 22601-6906 |
Second Address | Winchester, VA 22601-6906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 26/05/2021 |