Individual
MACDARA GERARD TYNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
282 WASHINGTON ST, HARTFORD, CT 06106-3322
(860) 837-5506
(860) 837-5540
Mailing address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 318-6800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200600478
NC
208M00000X
Hospitalist Physician
200600478
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142KK
BCBS
NC
05
—
5903367
—
NC
05
—
N78008
—
SC
Enumeration date
10/13/2005
Last updated
02/25/2025
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