Provider Demographics
NPI:1528605912
Name:MCCANN, STEPHEN (APRN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCCANN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 CARTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5845
Mailing Address - Country:US
Mailing Address - Phone:844-365-2202
Mailing Address - Fax:844-558-1878
Practice Address - Street 1:360 E PULASKI HWY FL 3
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6457
Practice Address - Country:US
Practice Address - Phone:844-365-2202
Practice Address - Fax:844-558-1878
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001340363LF0000X, 363LP2300X
MDAC004082363LF0000X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250571626Medicaid