Active NPI
Jeremy David McCullough, D.O.
- Aerospace Medicine Physician
- Oak Harbor, WA
National Provider Identifier
1104112747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- 010220312
- Practice address
- 3475 N Saratoga St
Oak Harbor, WA 98278-0001 - Phone
- (360) 257-9972
- NPI assigned
- Jun 22, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | 010220312 | VA | Primary |
Addresses
Primary practice location
3475 N Saratoga St
Oak Harbor, WA 98278-0001
Mailing address
10318 Strathmore Hall St
Apt. 408
Rockville, MD 20852-6635
Phone (786) 512-1488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010220312 | VA | MD | Aerospace Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668038400000",
"number": "1104112747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10318 STRATHMORE HALL ST",
"address_2": "APT. 408",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208526635",
"telephone_number": "786-512-1488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3475 N SARATOGA ST",
"city": "OAK HARBOR",
"state": "WA",
"postal_code": "982780001",
"telephone_number": "360-257-9972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "JEREMY",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-22",
"last_updated": "2022-11-10",
"certification_date": "2022-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "VA",
"license": "010220312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.