Kathleen Maccarthy Demanivel, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

31117 Issued in MN

Practice address

14500 99TH Ave N
Maple Grove, MN 55369-4478

Phone

(763) 898-1000

NPI assigned

Oct 25, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Kathleen Gael Maccarthy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1477543957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694478",
            "telephone_number": "763-898-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694478",
            "telephone_number": "763-898-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMANIVEL",
        "first_name": "KATHLEEN",
        "middle_name": "MACCARTHY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "31117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550507100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "MACCARTHY",
            "middle_name": "GAEL",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa Dee, LMFT
• Cheryl Lynn Cody Deets, MD
• Lana Dehmer, LMT
• Rosa Delgado
• Jonathan Dell, D.O.
• Jacynte R Denardo, LPCC
• Dental Delivery Systems of Maple Grove LLC
• Dental Specialists of Minnesota, PLLC
• Dentalign P.a.
• Derm on Demand LLC

• Dermatology Physician in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.