Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT197425 | PA |
N | 208600000X | Surgeon | MT197425 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD2018-0635 | NM |
NPI | 1114245032 |
---|---|
Provider Name | Fenton Mccarthy |
First Address | Albuquerque, NM 87102-2512 |
Second Address | Albuquerque, NM 87102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 13/11/2018 |